The beginning of the end

[Techmed07]

Colorado psychologists will be eligible to prescribe mental health medication under new law

Psychologists in Colorado will be allowed to write prescriptions if they’re willing to obtain an additional two-year degree, under a new law.

coloradosun.com

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[PikminOC]

Doesn't matter

 

[calvinhobbes]

Ehh most psychologists won’t want to do this, TBH.

 

[calvnandhobbs68]

Meh this is already a thing in a few states. I've said this before but NPs are way more of a problem in psychiatry than the "prescribing psychologists" thing, although it's a dumb idea to begin with. This is pretty small potatoes in terms of actual numbers and impact.

Also I'm sure the PCPs in Colorado are going to be really pleased when they find out their patient is seeing a "prescribing psychologist" instead of a psychiatrist and they get to deal with this. I mean **** the PCPs might as well just write the meds themselves at this point.

https://leg.colorado.gov/sites/default/files/2023a_1071_signed.pdf

- "BEFORE PRESCRIBING OR ADMINISTERING A PSYCHOTROPIC MEDICATION TO A PATIENT, A PRESCRIBING PSYCHOLOGIST SHALL COMMUNICATE TO THE PATIENT'S PRIMARY TREATING PHYSICIAN THE INTENT TO PRESCRIBE OR ADMINISTER THE MEDICATION AND MUST RECEIVE ELECTRONIC WRITTEN AGREEMENT FROM THE PHYSICIAN THAT THE PRESCRIPTION FOR OR ADMINISTERING OF THE MEDICATION IS APPROPRIATE."

- "WHEN PRESCRIBING A PSYCHOTROPIC MEDICATION FOR A PATIENT, THE PRESCRIBING PSYCHOLOGIST SHALL MAINTAIN AN ONGOING COLLABORATIVE RELATIONSHIP WITH THE PHYSICIAN WHO OVERSEES THE PATIENT'S GENERAL MEDICAL CARE TO ENSURE THAT NECESSARY MEDICAL EXAMINATIONS ARE CONDUCTED, THE PSYCHOTROPIC MEDICATION IS APPROPRIATE FOR THE PATIENT'S MEDICAL CONDITION, AND SIGNIFICANT CHANGES IN THE PATIENT'S MEDICAL OR PSYCHOLOGICAL CONDITIONS ARE DISCUSSED."

 

[Bartelby]

I agree with the above, the number of psychologists willing to do an additional two-year degree and prescribe in collaboration with a physician seems like a lot less of a threat than the large volume of NPs entering the market.

 

[tr]

Meh this is already a thing in a few states. I've said this before but NPs are way more of a problem in psychiatry than the "prescribing psychologists" thing, although it's a dumb idea to begin with. This is pretty small potatoes in terms of actual numbers and impact.

Also I'm sure the PCPs in Colorado are going to be really pleased when they find out their patient is seeing a "prescribing psychologist" instead of a psychiatrist and they get to deal with this. I mean **** the PCPs might as well just write the meds themselves at this point.

https://leg.colorado.gov/sites/default/files/2023a_1071_signed.pdf

- "BEFORE PRESCRIBING OR ADMINISTERING A PSYCHOTROPIC MEDICATION TO A PATIENT, A PRESCRIBING PSYCHOLOGIST SHALL COMMUNICATE TO THE PATIENT'S PRIMARY TREATING PHYSICIAN THE INTENT TO PRESCRIBE OR ADMINISTER THE MEDICATION AND MUST RECEIVE ELECTRONIC WRITTEN AGREEMENT FROM THE PHYSICIAN THAT THE PRESCRIPTION FOR OR ADMINISTERING OF THE MEDICATION IS APPROPRIATE."

- "WHEN PRESCRIBING A PSYCHOTROPIC MEDICATION FOR A PATIENT, THE PRESCRIBING PSYCHOLOGIST SHALL MAINTAIN AN ONGOING COLLABORATIVE RELATIONSHIP WITH THE PHYSICIAN WHO OVERSEES THE PATIENT'S GENERAL MEDICAL CARE TO ENSURE THAT NECESSARY MEDICAL EXAMINATIONS ARE CONDUCTED, THE PSYCHOTROPIC MEDICATION IS APPROPRIATE FOR THE PATIENT'S MEDICAL CONDITION, AND SIGNIFICANT CHANGES IN THE PATIENT'S MEDICAL OR PSYCHOLOGICAL CONDITIONS ARE DISCUSSED."

Good Lord that is the dumbest legislation ever. No incentive for the PCPs to comply with this unfunded mandate to lay their licenses on the line for an unknown treatment provider in a treating relationship they are not party to and can neither monitor nor bill for.

If I were a PCP and received a request like this I'd just ignore it completely. Spam.

 

[WisNeuro]

While I doubt that they'll have all that much trouble finding collaborating physicians, I also agree that the number will be relatively small, and a drop in the bucket against NP/PA encroachment in to the MH prescribing space. I think Illinois signed their RxP into law in 2014 and had 13 prescribing psychologists as of last summer. There are something like 150 more in the pipeline, but that number will always be relatively small compared to the overall number of psychologists.

 

[annoyedpsychiatrist]

if i remember correctly, pharmacists at the VA were writing psych meds at one point

 

[nexus73]

I agree with the above, the number of psychologists willing to do an additional two-year degree and prescribe in collaboration with a physician seems like a lot less of a threat than the large volume of NPs entering the market.

Is it really 2 years? My understanding was more so night and weekends while still working full time for 2 years. My biggest gripe is they could create PA programs with more psych exposure for these psychologists, but I assume nobody wants to actually go to school full time for 26 months, to get actual medical training. They want a shortcut.

 

[calvnandhobbs68]

Is it really 2 years? My understanding was more so night and weekends while still working full time for 2 years. My biggest gripe is they could create PA programs with more psych exposure for these psychologists, but I assume nobody wants to actually go to school full time for 26 months, to get actual medical training. They want a shortcut.

For sure it's absolutely a shortcut. Looks like the illinois one is super duper rigorous, look you can do your whole degree completely online!

Learn More - Clinical Psychopharmacology - The Chicago School

www.thechicagoschool.edu

Clinical Psychopharmacology MS

The M.S. in Clinical Psychopharmacology was developed as a postdoctoral program for licensed psychologists to prepare for prescriptive authority.

www.fdu.edu

Imagine being prescribed antipsychotics or stimulants by someone who might have never actually touched a real patient or done vitals in their life. I'm no NP fan but at least they have to go to nursing school first. Again it's not really a threat compared to NPs but it's an obvious money grab where the underlying assumption is that we need more undertrained people doling out psychotropic meds to the population THAT'S the real problem with the system right now.

 

[littlefred]

if i remember correctly, pharmacists at the VA were writing psych meds at one point

You mean clinical pharmacy specialists?
They even have residencies and call themselves residents

They supervise themselves (no MD interaction required) and prescribe meds. I believe they don't do controlled substances though.

 

[smalltownpsych]

If I wanted to be a psychiatrist, then I would have gone to med school. I prefer excelling at being a psychologist, which is a challenge enough for anyone, than being a half-assed psychiatrist. Just because PCPs and NPs that know very little about what they are doing are doing a really bad job doesn’t mean I should jump in to do a mediocre job.

 

[littlefred]

If I wanted to be a psychiatrist, then I would have gone to med school. I prefer excelling at being a psychologist, which is a challenge enough for anyone, than being a half-assed psychiatrist. Just because PCPs and NPs that know very little about what they are doing are doing a really bad job doesn’t mean I should jump in to do a mediocre job.

Wish more people had this much insight.

 

[PikminOC]

For sure it's absolutely a shortcut. Looks like the illinois one is super duper rigorous, look you can do your whole degree completely online!

Learn More - Clinical Psychopharmacology - The Chicago School

www.thechicagoschool.edu

Clinical Psychopharmacology MS

The M.S. in Clinical Psychopharmacology was developed as a postdoctoral program for licensed psychologists to prepare for prescriptive authority.

www.fdu.edu

Imagine being prescribed antipsychotics or stimulants by someone who might have never actually touched a real patient or done vitals in their life. I'm no NP fan but at least they have to go to nursing school first. Again it's not really a threat compared to NPs but it's an obvious money grab where the underlying assumption is that we need more undertrained people doling out psychotropic meds to the population THAT'S the real problem with the system right now.

The Illinois psychologists originally wanted to do this with ten hours of online training. It was finally negotiated up to these levels.

 

[PikminOC]

For sure it's absolutely a shortcut. Looks like the illinois one is super duper rigorous, look you can do your whole degree completely online!

Learn More - Clinical Psychopharmacology - The Chicago School

www.thechicagoschool.edu

Clinical Psychopharmacology MS

The M.S. in Clinical Psychopharmacology was developed as a postdoctoral program for licensed psychologists to prepare for prescriptive authority.

www.fdu.edu

Imagine being prescribed antipsychotics or stimulants by someone who might have never actually touched a real patient or done vitals in their life. I'm no NP fan but at least they have to go to nursing school first. Again it's not really a threat compared to NPs but it's an obvious money grab where the underlying assumption is that we need more undertrained people doling out psychotropic meds to the population THAT'S the real problem with the system right now.

I think Illinois psychologists can't prescribe controlled subs. Afaik

 

[PikminOC]

While I doubt that they'll have all that much trouble finding collaborating physicians, I also agree that the number will be relatively small, and a drop in the bucket against NP/PA encroachment in to the MH prescribing space. I think Illinois signed their RxP into law in 2014 and had 13 prescribing psychologists as of last summer. There are something like 150 more in the pipeline, but that number will always be relatively small compared to the overall number of psychologists.

Was it 2014 or more recently?

 

[WisNeuro]

Was it 2014 or more recently?

The bill was signed into law in 2014, though the final rules and regs were formalized a few years later.

 

[Techmed07]

We just can’t contend with PAs, NPs and psychologists. We surely will be outnumbered and out lobbied.

 

[WisNeuro]

We just can’t contend with PAs, NPs and psychologists. We surely will be outnumbered and out lobbied.

Ship has sailed in terms of Rx privileges with those professions. It's just delaying the inevitable at this time. A better use of your time and resources would be in a campaign to convince stakeholders that while others can prescribe, psychiatry is the expert profession in the area.

 

[PikminOC]

Ship has sailed in terms of Rx privileges with those professions. It's just delaying the inevitable at this time. A better use of your time and resources would be in a campaign to convince stakeholders that while others can prescribe, psychiatry is the expert profession in the area.

Corporate hospitals don't care. They just see the numbers. One Psychiatrist to take the hit for several np.

 

[finalpsychyear]

The solution to this and all the other bs in medicine is to achieve FI and then whatever happens you are set no matter what. Hoping to get there by end of decade and then work for fun. Otherwise you'll go insane with what is happening and what will happen in medicine going forward.

Medicine is purely a business in the states. But shhhh don't tell doctors that... whenever we need something we'll throw in some bs statements such as best for the patient situation which just entails more uncompensated work for the doc and more money in the pockets of all the other players routinely spouted by admins.

 

[calvnandhobbs68]

While I doubt that they'll have all that much trouble finding collaborating physicians

Also, this isn't "collaborating physicians" in this bill in the sense that NPs have "collaborating" physician (AKA someone to just sign off on 10% of your charts saying you're doing a good job). They have to communicate with every patient's individual PCP to do all the stuff above, it's actually fairly extensive, basically admitting that these people won't know how to do any sort of physical exam, not even be able to tell on their own whether the medication they're prescribing is "appropriate" for any medical condition and any lab testing and is clearly trying to throw liability onto the PCP.

So if you're a PCP, why the heck would I agree to any of this and just prescribe the meds myself?

 

[WisNeuro]

Also, this isn't "collaborating physicians" in this bill in the sense that NPs have "collaborating" physician (AKA someone to just sign off on 10% of your charts saying you're doing a good job). They have to communicate with every patient's individual PCP to do all the stuff above, it's actually fairly extensive, basically admitting that these people won't know how to do any sort of physical exam, not even be able to tell on their own whether the medication they're prescribing is "appropriate" for any medical condition and any lab testing and is clearly trying to throw liability onto the PCP.

So if you're a PCP, why the heck would I agree to any of this and just prescribe the meds myself?

I would imagine some sort of financial agreement. Between the clinical and legal realms I see providers of all types willing to do pretty much anything for a little bit of money. Also, many primary care providers out there who do not want to go anywhere near psych med management who would gladly sign off. I don't necessarily disagree with all of your concerns, but I have no doubt that some PCPs will go along with this.

 

[comp1]

The actual news here is that this law is EXTREMELY restrictive compared to other states that have launched this. I concur with the above posters who said very few will do this and it will have absolutely no impact on psychiatrists' practice whatsoever. And in regards to the pharmacists at the VA and DoD, they tend to manage psych meds a lot better than many PCPs. They had more formal training in the matter.

 

[WisNeuro]

Illinois did this ~ a decade ago. Last I checked only a dozen psychologists can prescribe here. People go into psychology to do therapy, not to rx meds

And research, and psych assessment, and neuropsych assessment, and consultation, and legal work of various forms, etc. And within the past several decades, a small contingent will go with the intent of RxP as part of their practice. I agree that it's not something to worry about, but the numbers will climb prior to a plateau like the states that have been doing this for a couple of decades now.

 

[tr]

I think Illinois psychologists can't prescribe controlled subs. Afaik

That's a weird line to draw. I would imagine psychologists could do very well managing addiction issues.

The meds that really need in-depth medical training to manage would be lithium, clozapine, and to some extent the other atypicals as well (because of the broader medical background needed to manage side effects like orthostasis and glucose dysregulation).

I think it makes a lot of sense to designate certain types of meds that can be prescribed without an MD - e.g. SSRIs are pretty benign - but I don't think doing it by DEA schedule is really that logical.

 

[VA Hopeful Dr]

Good Lord that is the dumbest legislation ever. No incentive for the PCPs to comply with this unfunded mandate to lay their licenses on the line for an unknown treatment provider in a treating relationship they are not party to and can neither monitor nor bill for.

If I were a PCP and received a request like this I'd just ignore it completely. Spam.

That's exactly what I'd do

 

[reca]

Lol, you guys really think they won't find doctors to put their license on the line? Do you realize that Cerebral still hires psychiatrists to supervise midlevels? I know someone who agreed to supervise 4 midlevels for $800/month fresh out of residency.

There will be no issue finding physicians to collaborate with. NP's and PA's have no problem finding them. There's even tips from NP blogs about looking up physicians with recent board sanctions and approaching them directly because they're more likely to say yes for a lower sum of money.

 

[PikminOC]

That's a weird line to draw. I would imagine psychologists could do very well managing addiction issues.

The meds that really need in-depth medical training to manage would be lithium, clozapine, and to some extent the other atypicals as well (because of the broader medical background needed to manage side effects like orthostasis and glucose dysregulation).

I think it makes a lot of sense to designate certain types of meds that can be prescribed without an MD - e.g. SSRIs are pretty benign - but I don't think doing it by DEA schedule is really that logical.

There's already too many stimulants and benzos being prescribed. We don't need more out there.

 

[PikminOC]

Lol, you guys really think they won't find doctors to put their license on the line? Do you realize that Cerebral still hires psychiatrists to supervise midlevels? I know someone who agreed to supervise 4 midlevels for $800/month fresh out of residency.

There will be no issue finding physicians to collaborate with. NP's and PA's have no problem finding them. There's even tips from NP blogs about looking up physicians with recent board sanctions and approaching them directly because they're more likely to say yes for a lower sum of money.

And there are companies that connect midlevels with physicians to sign.

 

[PikminOC]

And research, and psych assessment, and neuropsych assessment, and consultation, and legal work of various forms, etc. And within the past several decades, a small contingent will go with the intent of RxP as part of their practice. I agree that it's not something to worry about, but the numbers will climb prior to a plateau like the states that have been doing this for a couple of decades now.

The large diploma mills are the ones who put a ton of money towards lobbying for this legislation. They may start churning out more.

 

[splik]

I agree with the above, the number of psychologists willing to do an additional two-year degree and prescribe in collaboration with a physician seems like a lot less of a threat than the large volume of NPs entering the market.

Indeed. There are only about 225 prescribing psychologists in the US and it has taken 21 years for 6 states to enact prescribing psychologist legislation, most of which has significant restrictions or onerous requirements. In contrast, according to the AANP in 2018 there were 248000 NPs but by 2022 there were 355000. In 2016-2017, 1.7% of NPs were adult psych NPs and 2.1% were family psych, for 2020-2021 6.5% were psych NPs (who can now see children as well). The government projected a 65% increase in psych NPs between 2017 and 2030. Per the AANP state of the profession report, Psych/MH is the most lucrative certification for NPs. Psych NPs shockingly also write the most prescriptions out of all NPs, with a mean of 27 prescriptions per day.

Interestingly, workforce predictions suggest that the Psych NP field will become oversaturated in the next few years, whereas the demand for psychiatrists will continue to grow due to attrition of psychiatrists and changing workforce. According the HRSA: "Between 2017 and 2030, the total supply of all psychiatrists is projected to decline as retirements exceed new entrants. Rapid growth in supply of psychiatric nurse practitioners and psychiatric physician assistants may help blunt the shortfall of psychiatrists, but not fully offset it. In 2030, the supply of these three types of providers will not be sufficient to provide any higher level of care than the national average in 2017, which does not fully meet need."

Looking over the next 30 years, it becomes much harder to make accurate predictions, but the studies done so far indicate at best a minor surplus of psychiatrists by 2050, and at worst, a continued deficiency. In short, the sky isn't falling.

 

[ObsequiousAplomb]

Indeed. There are only about 225 prescribing psychologists in the US and it has taken 21 years for 6 states to enact prescribing psychologist legislation, most of which has significant restrictions or onerous requirements. In contrast, according to the AANP in 2018 there were 248000 NPs but by 2022 there were 355000. In 2016-2017, 1.7% of NPs were adult psych NPs and 2.1% were family psych, for 2020-2021 6.5% were psych NPs (who can now see children as well). The government projected a 65% increase in psych NPs between 2017 and 2030. Per the AANP state of the profession report, Psych/MH is the most lucrative certification for NPs. Psych NPs shockingly also write the most prescriptions out of all NPs, with a mean of 27 prescriptions per day.

Interestingly, workforce predictions suggest that the Psych NP field will become oversaturated in the next few years, whereas the demand for psychiatrists will continue to grow due to attrition of psychiatrists and changing workforce. According the HRSA: "Between 2017 and 2030, the total supply of all psychiatrists is projected to decline as retirements exceed new entrants. Rapid growth in supply of psychiatric nurse practitioners and psychiatric physician assistants may help blunt the shortfall of psychiatrists, but not fully offset it. In 2030, the supply of these three types of providers will not be sufficient to provide any higher level of care than the national average in 2017, which does not fully meet need."

Looking over the next 30 years, it becomes much harder to make accurate predictions, but the studies done so far indicate at best a minor surplus of psychiatrists by 2050, and at worst, a continued deficiency. In short, the sky isn't falling.

Mean of 27 psych NP Rx per day? That's honestly a lot fewer than I had suspected. Based on the regimens I see them prescribing, that's what, 3 patients per day?

 

[WisNeuro]

The large diploma mills are the ones who put a ton of money towards lobbying for this legislation. They may start churning out more.

Where are you finding the data on sources of funding for the legislation?

 

[PikminOC]

Where are you finding the data on sources of funding for the legislation?

It was a while ago when they gave their final push in Illinois. Psychologists had lobbied for it many times. The final time when it passed they had a lot more money from these many diploma mills set up in Illinois. I don't have the data now.

 

[WisNeuro]

It was a while ago when they gave their final push in Illinois. Psychologists had lobbied for it many times. The final time when it passed they had a lot more money from these many diploma mills set up in Illinois. I don't have the data now.

I am not familiar with the push for Illinois, as that was before I joined executive leadership, but I am familiar with two of the recent ones, and they were almost entirely state association driven, with one receiving a small APA grant. So, was just curious if there was actual data to support that assertion.

 

[smalltownpsych]

It was a while ago when they gave their final push in Illinois. Psychologists had lobbied for it many times. The final time when it passed they had a lot more money from these many diploma mills set up in Illinois. I don't have the data now.

In Illinois, in would make some sense that a school like Chicago School of Professional Psychology to support something like this because they would also sell the education to meet the requirements. In the state I live in we don’t have a professional school so it was the state psychological association that promoted it and got it through the legislature. Most of us are too busy doing what psychologists do, as Wisneuro stated, and making decent money at it so not too eager to jump into extra time and money to pursue this. I was thinking about it recently as I saw that my patients were getting bad treatment from the local NPs, but several local hospitals have been replacing psychiatrists with NPs and one is shrinking their mental health department so now my patients are getting more options in the community as these docs are going private practice.

 

[PikminOC]

These rxp pushed by psychologists have been tried many times. They needed the extra money by the diploma mills to get the success they had. Otherwise it would have been the same failure as they always had.

 

[PikminOC]

Indeed. There are only about 225 prescribing psychologists in the US and it has taken 21 years for 6 states to enact prescribing psychologist legislation, most of which has significant restrictions or onerous requirements. In contrast, according to the AANP in 2018 there were 248000 NPs but by 2022 there were 355000. In 2016-2017, 1.7% of NPs were adult psych NPs and 2.1% were family psych, for 2020-2021 6.5% were psych NPs (who can now see children as well). The government projected a 65% increase in psych NPs between 2017 and 2030. Per the AANP state of the profession report, Psych/MH is the most lucrative certification for NPs. Psych NPs shockingly also write the most prescriptions out of all NPs, with a mean of 27 prescriptions per day.

Interestingly, workforce predictions suggest that the Psych NP field will become oversaturated in the next few years, whereas the demand for psychiatrists will continue to grow due to attrition of psychiatrists and changing workforce. According the HRSA: "Between 2017 and 2030, the total supply of all psychiatrists is projected to decline as retirements exceed new entrants. Rapid growth in supply of psychiatric nurse practitioners and psychiatric physician assistants may help blunt the shortfall of psychiatrists, but not fully offset it. In 2030, the supply of these three types of providers will not be sufficient to provide any higher level of care than the national average in 2017, which does not fully meet need."

Looking over the next 30 years, it becomes much harder to make accurate predictions, but the studies done so far indicate at best a minor surplus of psychiatrists by 2050, and at worst, a continued deficiency. In short, the sky isn't falling.

The requirements aren't onerous. Only to the people who want a shortcut.

 

[WisNeuro]

These rxp pushed by psychologists have been tried many times. They needed the extra money by the diploma mills to get the success they had. Otherwise it would have been the same failure as they always had.

Again, where are you getting this info from? It is simply not true in at least several of the recent situations.

 

[PikminOC]

Again, where are you getting this info from? It is simply not true in at least several of the recent situations.

I don't have it now at my fingertips. When it was passing in Illinois it was revealed then as to the extra funding. That was a while ago. The apa couldn't do it on their own as they had tried and failed many times

 

[WisNeuro]

I don't have it now at my fingertips. When it was passing in Illinois it was revealed then as to the extra funding. That was a while ago. The apa couldn't do it on their own as they had tried and failed many times

I'm skeptical as this isn't how state legislation is generally passed by state associations, and also depending on their 501c3/6 status. If you find this data, I'd be curious to see it.

 

[MacDonaldTriad]

This isn't going to rock the foundation of the practice of psychiatry. Psychiatrists are in great demand and we are far from saturating the market. NPs and PCPs, and GPs are all practicing psychiatry of variable quality because they have no alternatives and do the best they can. A few more people writing psychotropics badly isn't going to cause the sky to fall.

 

[R. Matey]

Ehh most psychologists won’t want to do this, TBH.

Yep, I don't have a Ph.D. in meds.

 

[nexus73]

Prescribing psychologists seeing patient for therapy and prescribing 20 mg Prozac isn't really the issue. That patient is probably managed by PCP right now anyways so it just relieves the PCP from that work. But the less straight forward cases of TRD clearly start to become problematic when you are combining meds, using lithium, atypicals, and of course being aware of the patient's other medical conditions and non psychiatric prescriptions and what interactions can occur. There is no way a psychologist will have the training to do this. What I've seen is low income clinics championing a psychologist who has been there for a period of time to get rx privileges, and then expect them to takeover SPMI level patients. Which is completely unsafe.

 

[Techmed07]

Looking at the data it appears that the encroachment on our field is extremely problematic.

 

[Merovinge]

View attachment 367750
Looking at the data it appears that the encroachment on our field is extremely problematic.

I appreciate that chart but I'm not sure that's the only data worth looking at. Wasn't there only a handful of open spots post-match this year across the whole country? Fields that have lots of open spots post match seem to be a much worse space (e.g. EM).

 

[WisNeuro]

I appreciate that chart but I'm not sure that's the only data worth looking at. Wasn't there only a handful of open spots post-match this year across the whole country? Fields that have lots of open spots post match seem to be a much worse space (e.g. EM).

Yeah, that was a weird takeaway for that chart. By that logic,one would be arguing that encroachment from midlevels has actually affected EM, FM, Peds, and Vascular Surgery to a greater extent. You need a lot more data than that chart to empirically look at the effect of midlevel and RxP MH prescribing.

 

[nexus73]

I think psychiatry became more popular for a period of time, probably related to increased reimbursement with e/m coding and therapy add ons, and perceived improved acceptance by society and reduced stigma. But stigma still permeates everything I do at the hospital, even among doctors and physician administrators, who should know better or have better perspective on what psychiatry does. But in all fairness, they had 4 weeks of psych rotation in 3rd med school, so they really don't know what psychiatry is all about. And improved reimbursement is great, but inflation is running wild with no sign of reimbursement catching up. Getting a psych job at 280K sounds fine to pay off 200K in loans 5-10 years ago. But maybe the dream of psych as a lower paying ROAD specialty are going out the window with people eyeing the 400K plus starting salaries of anesthesia as they're facing down 500K in student loans.

 

[hebel]

View attachment 367750
Looking at the data it appears that the encroachment on our field is extremely problematic.

I actually think the real story is that psychiatry has stopped being a bottom-of-the-barrel specialty as far as competitiveness goes, so there's less "easy backup" applications being submitted by people gunning for another specialty because it's no longer a super easy match.