PhD/PsyD RxP for Psychologist approved in Hawaii

[OneNeuroDoctor]

Illinois approved last year and now Hawaii. This means NM, LA, ILL, and now HA will have prescribing psychologist. Apparently Texas is preparing to introduce RxP legislation this year since Texas Legislators are only in session every other year. It seems that after 12-years since NM passed their law of trying to get RxP for psychologist passed by other state legislators that it is becoming reality. NJ almost passed RxP last year.

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[futureapppsy2]

IL basically requires a Physician Assistant degree for RxP, so that doesn't really count, IMO.

 

[Therapist4Chnge]

IL basically requires a Physician Assistant degree for RxP, so that doesn't really count, IMO.

Good idea, but poorly implemented.

 

[OneNeuroDoctor]

They are basically equivalent but now new graduates will be able to prescribe once they graduate rather than needing to complete postdoctoral two-years of training. Actually, the Illinois law is very good for current students or newly graduated students.

 

[futurepsydoc]

I am curious how people feel about laws like this being passed. I am quite conflicted about the notion of psychologists being able to prescribe psychotropic medications. Given the differences across states, I believe a broader policy for training needs to be developed to ensure adequate education. I think there should be clear uniformity in training. What to do others think?

 

[WisNeuro]

I like the idea of RxP in principle. I hate how it is (mostly) being implemented. I think it's becoming ripe for diploma mills to step in and try to create mostly online training programs for it.

 

[DynamicDidactic]

link?

all I see on the Facebook page is that it passed it through a committee.

 

[WisNeuro]

link?

all I see on the Facebook page is that it passed it through a committee.

Here's is the last action I see as having been done on it

"The committee(s) on JDL recommend(s) that the measure be PASSED, WITH AMENDMENTS." on 2/25/2016. SO, yeah, looks like it is out of committee, but not yet passed by the legislature.

 

[DynamicDidactic]

this sort of misinformation (or straight up deceit) drives me nuts




How does one "Stop Suicide Trend" with RxP? Absolutely no credible or replicated evidence that medication reduces suicide. If anything, its the best support for behavioral treatments rather than relying on the spurious belief that psychopharm solves everything.

 

[OneNeuroDoctor]

It has gone through House and Senate from what D55 listserv and basically it has passed.

 

[WisNeuro]

Because antidepressants stop people from having suicidal thoughts. Everyone knows that.

 

[Justanothergrad]

Honestly, I think it is inevitable because the need for psychiatry just isn't (and hasn't been) able to keep up with the need for providers aware of psychiatric care. What happens in rural areas (and has for decades) is that new psychiatrists come in, work for a year or two, then leave to go make 250+k elsewhere. The area is then without someone for 6+ months and then the 3 month (at very best, often 5 or so) wait list keeps people only able to see someone once before they are gone. Bad continuity makes for bad care, in addition to the lack of service. And all that assumes they don't just go to a GP that uses the MDQ to diagnosis bi-polar.

What I think breaks down like this:

Pros
---
It addresses the needs of under-served areas and populations (e.g., rural) that can't attract psychiatrists
We have better training in diagnosis (and honestly, even in some of the meds) than most GPs providing most of the psychiatric meds
It gives us another area to make us distinct from MA level practitioners (cause it sure isn't therapy pay rates) in line with NPs and such

Cons
---
Opens up a slippery slope for billing/managed care to push us into med management versus therapy/assessment
We don't have a strong training in the biological side to manage/understand side-effect presentation (this coincides with concern for malpractice)
I worry that, like neuro said, it will become an emphasis of diploma mills, particularly the worst offenders in training quality

 

[WisNeuro]

It has gone through House and Senate from what D55 listserv and basically it has passed.

No, it has passed reading from the House and Senate and referred back to committee. It still needs full votes. Things fail after coming out of committee all the time. Probably has a decent chance of passing, but it's not there yet.

 

[WisNeuro]

Additionally, if you read the bill and amendments, they amended the bill to follow closely with what Illinois did, essentially assuring that few people will go this route. Honestly, not exciting and probably won't do much as written even if passed.

 

[deleted343839]

Given the differences across states, I believe a broader policy for training needs to be developed to ensure adequate education. I think there should be clear uniformity in training. What to do others think?

I agree. I think joint psychologist/physician assistant programs would be a better model than postgraduate certificates.

 

[DynamicDidactic]

Honestly, I think it is inevitable because the need for psychiatry just isn't (and hasn't been) able to keep up with the need for providers aware of psychiatric care. What happens in rural areas (and has for decades) is that new psychiatrists come in, work for a year or two, then leave to go make 250+k elsewhere. The area is then without someone for 6+ months and then the 3 month (at very best, often 5 or so) wait list keeps people only able to see someone once before they are gone. Bad continuity makes for bad care, in addition to the lack of service. And all that assumes they don't just go to a GP that uses the MDQ to diagnosis bi-polar.

What I think breaks down like this:

Pros
---
It addresses the needs of under-served areas and populations (e.g., rural) that can't attract psychiatrists
We have better training in diagnosis (and honestly, even in some of the meds) than most GPs providing most of the psychiatric meds
It gives us another area to make us distinct from MA level practitioners (cause it sure isn't therapy pay rates) in line with NPs and such

Cons
---
Opens up a slippery slope for billing/managed care to push us into med management versus therapy/assessment
We don't have a strong training in the biological side to manage/understand side-effect presentation (this coincides with concern for malpractice)
I worry that, like neuro said, it will become an emphasis of diploma mills, particularly the worst offenders in training quality

the pros/cons have been discussed to death in the main thread
http://forums.studentdoctor.net/threads/psychopharmacology-advanced-practice-psychology.244987/

the claims supporting RxP have not been supported by empirical results. For example, psychologists don't practice in rural areas either.

 

[DynamicDidactic]

They are basically equivalent but now new graduates will be able to prescribe once they graduate rather than needing to complete postdoctoral two-years of training. Actually, the Illinois law is very good for current students or newly graduated students.

Curious, the only program I am aware of in Hawaii is postdoctoral only.
https://www.hawaii.edu/news/2015/12/18/psychopharmacology-program-gains-apa-approval/

 

[AcronymAllergy]

the pros/cons have been discussed to death in the main thread
http://forums.studentdoctor.net/threads/psychopharmacology-advanced-practice-psychology.244987/

the claims supporting RxP have not been supported by empirical results. For example, psychologists don't practice in rural areas either.

To be fair, there's generally a shortage of prescribing providers everywhere, especially for those with limited/no insurance or who aren't able to do private pay. Rural areas are just particularly bad off. I actually think the same could be said of truly effective and competent providers of psychotherapy; that just doesn't get as much attention. Pretty much all the therapists (psychologists and social workers) at my clinic, for example, would be ecstatic if they could see a patient once a week, or sometimes even just twice a month.

All that being said, I do like at least the idea of incorporating the equivalent of psych-tailored PA or NP training into grad school to then allow for prescribing privileges. Unfortunately, as WisNeuro mentioned, I foresee that this might result in a lot of the typically-labeled "diploma mills" developing these programs, as they might be rather expensive.

And/or there's the concern about the role and training of psychologists becoming blurred, and for such programs to begin skimping on the psych side rather than the med side so that they essentially become PA programs with a little extra psych and research thrown in.

 

[Justanothergrad]

the pros/cons have been discussed to death in the main thread
http://forums.studentdoctor.net/threads/psychopharmacology-advanced-practice-psychology.244987/

the claims supporting RxP have not been supported by empirical results. For example, psychologists don't practice in rural areas either.

True, but there are more psychiatrists+psychologists in rural areas than there are psychiatrists alone.

 

[Therapist4Chnge]

the claims supporting RxP have not been supported by empirical results. For example, psychologists don't practice in rural areas either.

I haven't seen data to support they are more likely to practice in rural areas, though there is such a shortage everywhere that access to care issues aren't just a rural problem.

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Looks like AA jumped on the access to care issue while I was away.

 

[erg923]

I've always had a problem with the access to care argument bc it seems premised on the idea that MORE people need psychiatric medication. I've never been convinced of this, and generally believe the opposite.

 

[Justanothergrad]

I've always had a problem with the access to care argument bc it seems premised on the idea that MORE people need psychiatric medication. I've never been convinced of this, and generally believe the opposite.

My clinical focus is in rural and SMI populations and it's definitely an access to care issue for those folks. Not everyone needs more meds, but those that do try to get the help they need (particularly in under-served areas) end up in for some substantial trouble.

 

[Therapist4Chnge]

I too believe it is an access to care issue. I live in a big city, but we still have long waits to get pts into a psychiatrist. We have multiple counties that don't have ANY psychiatrists, and the FPs and PCPs that are trying to triage are well outside of tgeir comfort zones.

I'd argue that it isn't just about getting pts on meds, but it is also about taking them off. Unfortunately over-medication is an unintended consequence of how we aporoach mental health management.

 

[erg923]

My clinical focus is in rural and SMI populations and it's definitely an access to care issue for those folks. Not everyone needs more meds, but those that do try to get the help they need (particularly in under-served areas) end up in for some substantial trouble.

These are not the folks/population that Rx psychologists typically treat tho, right?

Can a typical Rx psychologist really medically monitor/manage clozaril, for example?

 

[Therapist4Chnge]

These are not the folks/population that Rx psychologists typically treat tho, right?

Can a typical Rx psychologist really medically monitor/manage clozaril, for example?

Come on erg923...that's not exactly the standard run of the mill pt population for your garden variety out-pt psychiatrist or nurse practitioner practicing in the community.

 

[deleted343839]

I appreciate erg's point. Access to mental health care should also imply access to first-line, empirically supported psychotherapies. I've always been curious about what percentage of prescribing psychologists are really competent in one or most ESTs.

I agree that the majority of patients who really depend on long-term medication management to function - i.e., would be in crisis without it - should not be managed by a psychologist alone, Rx privileges or not.

 

[cara susanna]

Honestly, I think it is inevitable because the need for psychiatry just isn't (and hasn't been) able to keep up with the need for providers aware of psychiatric care. What happens in rural areas (and has for decades) is that new psychiatrists come in, work for a year or two, then leave to go make 250+k elsewhere. The area is then without someone for 6+ months and then the 3 month (at very best, often 5 or so) wait list keeps people only able to see someone once before they are gone. Bad continuity makes for bad care, in addition to the lack of service. And all that assumes they don't just go to a GP that uses the MDQ to diagnosis bi-polar.

What I think breaks down like this:

Pros
---
It addresses the needs of under-served areas and populations (e.g., rural) that can't attract psychiatrists
We have better training in diagnosis (and honestly, even in some of the meds) than most GPs providing most of the psychiatric meds
It gives us another area to make us distinct from MA level practitioners (cause it sure isn't therapy pay rates) in line with NPs and such

Cons
---
Opens up a slippery slope for billing/managed care to push us into med management versus therapy/assessment
We don't have a strong training in the biological side to manage/understand side-effect presentation (this coincides with concern for malpractice)
I worry that, like neuro said, it will become an emphasis of diploma mills, particularly the worst offenders in training quality

My concern also is that it's going to make people consider us more as midlevel providers.

 

[erg923]

These are not the folks/population that Rx psychologists typically treat tho, right?

Can a typical Rx psychologist really medically monitor/manage clozaril, for example?

Extreme example, but that was the point. The answer is no, I would assume.

I'm sure some people with schizophrenia who live in a cabin 100 miles from nowhere are/will be helped. But, this is not really who most psychologists are/will be treating, lets face it. Yet, its used as leverage/rationale. In fact, the vast majority of psychotropics Rxs in this country are, and therefore the vast majority of Rxing psychologists will be doing, something along the lines of mostly SSRI/SNRIs for mild-moderate depression/anxiety, depakote for "impulsivity" and some trazadone for sleep. Do people really need more of this?

 

[smalltownpsych]

Extreme example, but that was the point. The answer is no, I would assume.

I'm sure some people with schizophrenia who live in cabin 100 miles from nowhere are/will be helped. But, this is not really who most psychologist are/will be treating, lets face it. Yet, its used as leverage/rationale. In fact the vast majority of psychotropics Rxs are, and therefore the vast majority of Rxing psychologists will be doing, something along the lines of mostly SSRI/SNRIs for mild-moderate depression/anxiety, depakote for "impulsivity" and some trazadone for sleep. Do people really need more of this?

Nope. The access to meds and reliance on medication as a panacea for all types of social and behavioral problems is a bigger issue in my opinion than access to psychotropics.

 

[PsyDr]

These are not the folks/population that Rx psychologists typically treat tho, right?

Can a typical Rx psychologist really medically monitor/manage clozaril, for example?

Most of the RxPs in NM are serving in federally defined rural areas. Don't know much about LA.

The associated AEs from clozaril is somewhat misleading. All patients seeing an Rxp have to be followed by a PCP. An RxP would order labs, put pt on the register, follow treatment guidelines, etc. but the pt is legally mandated to be followed by a Pcp. I wish I could say the same for psychiatry.

Could an RxP treat a PE. cardiomyopathy, etc from clozaril? Nope. But most psychiatrists are not going to treat this either. Both groups are going defer to the appropriate providers after doing their part.

Source: guy who could prescribe if he wanted, if it made financial sense, etc. Except I lost my dea number for a while. Not, had it removed or sanctioned, mind you. It just fell out of the hanging file in a filing cabinet and it took a while to locate.

 

[DynamicDidactic]

Ugh, do we have to keep retreading the same arguments.

The empirical evidence indicates that the increase in rural prescribing is insignificant. To keep beating that drum is subterfuge for the real reasons driving the RxP movement.

Most of the RxPs in NM are serving in federally defined rural areas.

show me the data. Last data I saw, which was a few years ago, showed that almost no NM RxP psychologists were practicing in a rural setting. I am sure its more now but most?

No one, through the years of this topic repeating itself, has ever addressed my biggest concern. RxP will ruin the field of clinical psychology as a science and behavioral treatment specialty. For-profit or tuition-focused programs will reign over the educational end of clinical psychology and the PhD as a traditional learned degree will go the way of the Dodo. All this despite the growing body of evidence that medication does **** for treating psychological disorders or you get some fun side effects.

I am always surprised by the people that take a data-driven view that incorporates the long-term benefit for the field when we talk about graduate education but don't do so for RxP.

 

[DynamicDidactic]

looks like I have never cursed in the forums before, didn't know about the censorship.

 

[futurepsydoc]

In my opinion, at least for the time being, the better move would be to develop more pathways for having psychologists in rural communities become embedded in family medicine practices that currently exist. Integrated treatment is burgeoning area of growth within healthcare at the present. I think developing legislation and programs, the latter being generated through public and private sector cooperation (i.e., recruitment, funding, strategies for increasing sustainability), would be ideal for increasing access in much needed areas.

Along these lines, PCPs treat depression and prescribe antidepressant medications at a tremendous rate. I think providing assessment, consultation, and psychotherapy, in conjunction with a PCP in family medicine, could be a more effective way to engage patients in treatment more generally. I think this would be true and in rural communities and metropolitan areas alike. I think the key is to have strong communication across providers and co-located care. I feel that having this set-up, could help reduce stigma to seeking treatment, especially if the PCPs are advocating for this model. The recent emphasis on interprofessional and interdisciplinary training, especially found within Academic Medical Centers, gives me hope that this could be truly viable way to bring mental health treatment to rural regions.

To note, I do not want this position to suggest that I am against legislation allowing psychologists to prescribe medications. To the contrary, I support it. Yet, I would like to see a uniform educational policy for training psychologists who are pursuing this role. Given the differences in the ways in which eligible states allow psychologists to prescribe, I am concerned that this could adversely impact the end goal on a national level.

To be honest, as it currently stands within the field of clinical psychology, we have a great deal of differences across doctoral training programs with respect to education and supervised training for assessment,diagnosis, and treatment. We need to look no further than the longstanding discourse pertaining to theoretical underpinnings for mechanisms of change across psychosocial/psychological treatments. As this forum has shown us, time and time again, there is also clear conflict amongst advocates supporting Boulder-model -vs- Vail-model programs. Within this context, I strongly believe we need to have uniformity across training for psychopharmacology. If we do not, I am concerned about the unforeseen consequences. I think others ought to be concerned as well.

 

[Therapist4Chnge]

The conflating factor here is the variable training between the top quartile and bottom quartile of programs, as they look very different in design and outcomes.

We need our of Flexner Report. After a re-evaluation of programs (whether it be APA or another group), then I think as a field we can nove forward.

As for psych RxP, I support it and have in multiple states over the years, but the training standards need to be raised and not diluted. I think the New Mexico training should be the floor and programs should have a greater focus in integrated medicine. That is where healthcare is going and that is where psychologists can leverage our training best. We don't want to be reduced to only a hammer, which is my concern w. the current model of healthcare and psych RxP. Insurance won't pay (enough) to make it possible to truly have an integrated model that is sustainable.

 

[futurepsydoc]

t4c, I agree we need that we need our Flexner Report. The struggle between APA and PCSAS, for example, highlights the internal conflict re: training and further supports your point that a comprehensive review process is needed. I think as the field attempts to extend the scope of practice for psychologists, the need and demand for intensive program evaluation akin to the Flexner report, will lead to it being conducted.