The price of peanuts in Iran

[50960]

Colleagues,

Forwarded to the list on request from Dr. Rubin:

I am writing to inform the Division 55 membership that a lawsuit was filed
in Federal court in Los Angeles on February 9, 2006, alleging that patients
in California are having their constitutional rights violated by not
receiving constitutionally adequate treatment because of the state's and
county's inability to provide competent psychiatric care to patients who are
in custody, in the state mental hospitals, in county jails, and county
mental health facilities. The three plaintiffs allegedly harmed by the State
of California contend that the necessary numbers of competent psychiatrists
are not available and never will be due to the declining numbers of
practicing psychiatrists and the continued unattractiveness of psychiatry as
a specialty to American medical school graduates.
In addition to the State of California, the complaint names a number of
people as defendants
including Governor. Schwarzenegger, the Secretary of the Department of
Corrections, and the Sheriff of Los Angeles County. Of specific importance
to Division 55 and psychologists in general, is that the lawsuit asks the
court to amend the statute prohibiting psychologists to prescribe
medication. The plaintiffs are asking the State of California to afford
appropriately trained psychologists prescriptive authority as a remedy to
California's access to care problem. Allowing appropriately trained
psychologists to prescribe medication is the least restrictive way that
California can provide constitutionally adequate treatment. For further
information, please contact Dr. Howard Rubin [email protected], or Dr. John
Caccavale at [email protected].

Dr. Howard Rubin
Chair, Legal Committee, CSCP



Please freak out and stop this atrocity anasazi

---

Members don't see this ad.

 

[Triathlon]

I don't get what the big deal is. There are plenty of psychologists that are appropriately trained to prescribe medications, unfortunately they are all too busy working as physicians now. Since they went to medical school.
What exactly does it mean appropriately trained?

 

[Anasazi23]

Please freak out and stop this atrocity anasazi

I wasn't going to dignify this obvious bait with a reply, but I'll let my worse judgement get the best of me. Being on-duty for over 24 hours now with no sleep probably has something to do with it.

The only solution to the above problem (clearly manipulated by unscrupulous psycologists) is to give you, psisci, prescription privilages so that you can work in the California prison system.

As is evident in the deserts of new mexico and the swamps of louisiana, the psychologists love to flock there - true to their words that they are concerned about patient care.

Good luck to you. I'm sure you'll love the prison system.

 

[Doc Samson]

Noooooo... don't give in. Sazi, I understand you're a little frontal from sleep deprivation, and Triathalon is new around here, so probably doesn't know better, but let's not rise to these pathetic attempts to bait us. Psychologist prescribing will die with the ever-increasing number of psychiatric medications with black box warnings. The whole premise is based on the myth that psychiatric medications are "safe" and "easy" to prescribe. Black boxes on atypicals and stimulants, and the increasing awareness of adverse effects of SSRIs are changing this. From a risk management perspective, psychologist prescribing is circling the drain.

 

[Anasazi23]

Yes, I'm being facetious Doc Samson. Psisci likes to get my goat. That's all. Seriously though, I wonder how they'll justify the data in 5 years when stats show that they refuse to move to the areas that they promise they'll help. Hmm....

Let me read this stuff more carefully:

Colleagues,

Forwarded to the list on request from Dr. Rubin:

I am writing to inform the Division 55 membership that a lawsuit was filed
in Federal court in Los Angeles on February 9, 2006, alleging that patients
in California are having their constitutional rights violated by not
receiving constitutionally adequate treatment because of the state's and
county's inability to provide competent psychiatric care to patients who are
in custody, in the state mental hospitals, in county jails, and county
mental health facilities.

They receive treatment...maybe not for every ridiculous complaint they have in a timely fashion, but they do. Prisons are notorious for non-serious complaints in attempts to clog the system and build SSD/transfer cases. This clearly shows naviete.

The three plaintiffs allegedly harmed by the State
of California contend that the necessary numbers of competent psychiatrists
are not available and never will be due to the declining numbers of
practicing psychiatrists and the continued unattractiveness of psychiatry as
a specialty to American medical school graduates.

Numbers of psychiatry residents have risen over the last 5 years. I posted these stats in another thread. These psychologists should do some research before they make grossly false claims.

In addition to the State of California, the complaint names a number of
people as defendants
including Governor. Schwarzenegger, the Secretary of the Department of
Corrections, and the Sheriff of Los Angeles County. Of specific importance
to Division 55 and psychologists in general, is that the lawsuit asks the
court to amend the statute prohibiting psychologists to prescribe
medication. The plaintiffs are asking the State of California to afford
appropriately trained psychologists prescriptive authority as a remedy to
California's access to care problem. Allowing appropriately trained
psychologists to prescribe medication is the least restrictive way that
California can provide constitutionally adequate treatment. For further
information, please contact Dr. Howard Rubin [email protected], or Dr. John
Caccavale at [email protected].

Dr. Howard Rubin
Chair, Legal Committee, CSCP

Again, data shows that psychologists will not do this (move to underserved areas). I also posted this data in previous threads. Psychologists attempting to prescribe to a highly litigenous population will spell disaster for them. They have no idea what they're attempting to get into. There's a reason psychiatrists (and other medical doctors) don't want to work there.

As for Doc's black box warning comment...I completely agree. Medically untrained professionals without completion of a psychiatric residency is wonderful fodder for trial lawyers who would love to investigate non-physicians trying to prescribe black-boxed psychiatric medications.


To preempt the predictible comment to follow I qualify the above:

Not that I care!
Not that I care!

 

[50960]

I love you guys!!! Relax. This is really happening, but I am really not trying to piss you off just have interesting banter.

......but Anasazi is right I love to get him going!!

 

[Harmony]

I love you guys!!! Relax. This is really happening, but I am really not trying to piss you off just have interesting banter.

......but Anasazi is right I love to get him going!!

From my sources, I came to know that the three plaintiffs are psisci, psycheval and PublicHealth. Just Kiddding.....

 

[PublicHealth]

Psisci should get prescriptive authority for his ingenious title for this thread.

Here's some more fodder:

--------------------------------------------------------------------------------

I thank Howard Rubin for sending out the message of the lawsuit we filed
> last week. Although we have been working hard to get this together for some
> time, we have had to keep as quiet as possible about our approach.
> We are very confident that the reasons we seek RxP will be given a fair
> hearing. Perhaps, the California legislature will also take note. We intend
> to] see this to the end. For the lawsuit we did a survey of all the
> psychiatrists who are listed in the phone book in Los Angeles County and
> tried to make an appointment. We hired a group to do this for us. I'm
> including the results here for everyone to see. If there was a question of
> access, this should put it to rest.
> My intention is to release as much evidence as possible so everyone can
> evaluate why we are so excited about this.
>
> Best,
> John
>
>
> *TELEPHONE SURVEY OF ALL PSYCHIATRISTS IN LOS ANGELES COUNTY LISTED IN THE
> SUPERPAGES TELEPHONE DIRECTORY *
>
> *SAMPLE*
> 228 listings for psychiatry for all of LA County, as listed at
> superpages.com Calls were made from mid-December, 2005. through the end of
> January, 2006
>
> *POLLSTER*
> The Mental Health Wellness Center, located in Long Beach, California.
>
> *METHOD*
> Calls were made by a female interviewer. The interviewer read from a
> prepared script.
> Calls were made between the hours of 9:00 AM and 3:00PM. When an answering
> machine was reached, the interviewer left a telephone number to be called
> back. All unreturned numbers were called back three times.
>
> *RESULTS*
> 10 numbers were improperly listed, 8 phones rang with no answering machine.
> 95 calls reached answering machines, only.
> 5 psychiatrists were on vacation and could not be reached.
>
> 7 offices insisted on interviewing the potential patient before they would
> decide to take patient.
> They offered to send out an "interview screening" package that would have
to
> be filled out and sent back for evaluation. If acceptable, the patient
would
> be notified.
>
> 55 psychiatrists said they were not accepting new patients.
>
> 48 psychiatrists said they were willing to take a new patient on a cash
> basis, only. Of this 48,
> 28 psychiatrists made an appointment. (These offices were called and appt
> cancelled).
> The other 20 could not provide an appointment date at the time of the call.
>
> Of the 28 psychiatrists who made an appointment:
>
> 2 were within 1 week 7 were within 2 weeks
> 4 were within 3 weeks 5 were within 4 weeks
> 5 were within 5 weeks 1 was within 6 weeks
> 1 was within 8 weeks 1 was within 9 weeks
> 1 was within 10 weeks 1 was within 11 weeks
>
> The cost of an initial assessment was collected from 38 psychiatrists, with
> mean of $420 and a median of $450.
>
> 5 charged $100-200
> 2 charged $201-300
> 9 charged $301-400
> 18 charged $401-500
> 4 charged $501-600

 

[Solideliquid]

Price of peanuts in Iran= $10 dollars

Psisci's new prescription pads= $100 dollars

Quietly dying from pancreatic cancer while psisci happy prescribes zoloft = priceless (at least the lawsuit will be)

 

[PublicHealth]

Price of peanuts in Iran= $10 dollars

Psisci's new prescription pads= $100 dollars

Quietly dying from pancreatic cancer while psisci happy prescribes zoloft = priceless (at least the lawsuit will be)

Same was said about optometrists, nurse practitioners, and physician assistants getting prescriptive authority. Malpractice rates have not changed.

 

[PublicHealth]

Here we go again...

 

[Anasazi23]

Psisci should get prescriptive authority for his ingenious title for this thread.

Here's some more fodder:

--------------------------------------------------------------------------------

I thank Howard Rubin for sending out the message of the lawsuit we filed
> last week. Although we have been working hard to get this together for some
> time, we have had to keep as quiet as possible about our approach.
> We are very confident that the reasons we seek RxP will be given a fair
> hearing. Perhaps, the California legislature will also take note. We intend
> to] see this to the end. For the lawsuit we did a survey of all the
> psychiatrists who are listed in the phone book in Los Angeles County and
> tried to make an appointment. We hired a group to do this for us. I'm
> including the results here for everyone to see. If there was a question of
> access, this should put it to rest.
> My intention is to release as much evidence as possible so everyone can
> evaluate why we are so excited about this.
>
> Best,
> John
>
>
> *TELEPHONE SURVEY OF ALL PSYCHIATRISTS IN LOS ANGELES COUNTY LISTED IN THE
> SUPERPAGES TELEPHONE DIRECTORY *
>
> *SAMPLE*
> 228 listings for psychiatry for all of LA County, as listed at
> superpages.com Calls were made from mid-December, 2005. through the end of
> January, 2006
>
> *POLLSTER*
> The Mental Health Wellness Center, located in Long Beach, California.
>
> *METHOD*
> Calls were made by a female interviewer. The interviewer read from a
> prepared script.
> Calls were made between the hours of 9:00 AM and 3:00PM. When an answering
> machine was reached, the interviewer left a telephone number to be called
> back. All unreturned numbers were called back three times.
>
> *RESULTS*
> 10 numbers were improperly listed, 8 phones rang with no answering machine.
> 95 calls reached answering machines, only.
> 5 psychiatrists were on vacation and could not be reached.
>
> 7 offices insisted on interviewing the potential patient before they would
> decide to take patient.
> They offered to send out an "interview screening" package that would have
to
> be filled out and sent back for evaluation. If acceptable, the patient
would
> be notified.
>
> 55 psychiatrists said they were not accepting new patients.
>
> 48 psychiatrists said they were willing to take a new patient on a cash
> basis, only. Of this 48,
> 28 psychiatrists made an appointment. (These offices were called and appt
> cancelled).
> The other 20 could not provide an appointment date at the time of the call.
>
> Of the 28 psychiatrists who made an appointment:
>
> 2 were within 1 week 7 were within 2 weeks
> 4 were within 3 weeks 5 were within 4 weeks
> 5 were within 5 weeks 1 was within 6 weeks
> 1 was within 8 weeks 1 was within 9 weeks
> 1 was within 10 weeks 1 was within 11 weeks
>
> The cost of an initial assessment was collected from 38 psychiatrists, with
> mean of $420 and a median of $450.
>
> 5 charged $100-200
> 2 charged $201-300
> 9 charged $301-400
> 18 charged $401-500
> 4 charged $501-600

Am I the only person that finds this unbelievably sleazy and borderline unethical?

Funny how this unscientific survey fails to mention that anyone can receive psychiatric treatment by simply walking into their local friendly ER. There, they are often treated and released, admitted, and referred to the hospital-affiliated clinic.

Did they bother calling the local psychiatric clinics (university and private) to ask them how long it would take to get an appointment? Or did they find that the pilot study's findings that many clinics take walk-ins didn't appeal to their study results? My money's on the latter.

They have yet to produce a study showing that psychologists are moving to underserved areas. This will be the downfall of further privilage rights, when the American Psychiatric Association proves that they're basically lying about their altruistic intentions.

This is great....as psychologists who understand research design, I'm sure they got a control or comparison group of their own profession. I'll just wait here for that data....

....
....

Hmm....

Ah well, I'm off to another drug dinner. This one's by Janssen for Risperdal Consta at one of my favorite restaurants. Nice to be at the top of the food chain.

*pardon the pun*

 

[Anasazi23]

From my sources, I came to know that the three plaintiffs are psisci, psycheval and PublicHealth. Just Kiddding.....

This actually made me laugh out loud.

 

[Doc Samson]

y'know... this whole psychologist prescribing thing might not be all bad... I'm envisioning a lucrative career as an expert witness for the prosecution in all the malpractice suits that follow. I'm off to call my wife... the kids can go to college after all!

 

[PublicHealth]

y'know... this whole psychologist prescribing thing might not be all bad... I'm envisioning a lucrative career as an expert witness for the prosecution in all the malpractice suits that follow. I'm off to call my wife... the kids can go to college after all!

Argument #3:

“Liability insurance premiums will increase drastically and those who do not prescribe will have to pay higher rates to compensate for those who do prescribe. Doesn’t the likelihood of mis-prescribing increase when psychologists, not physicians, prescribe?”

Counterpoints:

A. Over 70% of psychotropic medication in the United States is currently prescribed by non-psychiatric physicians who have minimal training in the detection and management of mental and emotional problems. Psychologists are much better trained and equipped to accurately diagnose and treat mental disorders.

B. Insurance premiums are rated based upon experience. The prescribing experience of Optometrists, Advanced Nurse Practitioners and Physician Assistants demonstrates that non-physician prescribers are as safe as physicians. Therefore, their premiums have not increased and are currently less expensive than the present liability rates for psychologists. Psychologists who oppose RxP fear substantial increases in liability insurance premiums. When medication is prescribed judiciously, as Optometrists and other non-physician prescribers have shown, there is no significant increase in premiums.

Reference: http://www.apa.org/apags/profdev/prespriv.html

 

[50960]

See what I have done, and it is not even friday! By the way everyone knows about the depression/tumor on the head of the pancreas thing, and the person would die waiting to see a psychiatrist before I killed them with zoloft. Aside from this, Anasazi can you tell me via IM about risperdal consta? I am being serious, and would like to learn how well it works. I have a schizo pt who thinks her voices have infected her meds so won't take them...sigh.. really.

 

[Poety]

The irony in psychologists prescribing is that OTHER PHYSICIANS don't even want to TOUCH psych meds anymore because of the side effects/interactions/ etc etc - obgyns, surgeons, and even family meds are referring out more and more to psychiaTRISTS and none-the-less, non-docs want to prescribe these - what the hell is going on here??

pfffffffffftttt

 

[Doc Samson]

Same was said about optometrists, nurse practitioners, and physician assistants getting prescriptive authority. Malpractice rates have not changed.

And optometrists, nurse practitioners, and physician assistants are exactly the same as psychologists... except they have medical training.

 

[Doc Samson]

Over 70% of psychotropic medication in the United States is currently prescribed by non-psychiatric physicians who have minimal training in the detection and management of mental and emotional problems. Psychologists are much better trained and equipped to accurately diagnose and treat mental disorders.

Right... the difficult part of psychopharm is making a DSM-IV diagnosis... not understanding all that simplistic neurobiology, cytochrome p450 interactions, or the multiple psychiatric presentations of medical illness.

 

[PublicHealth]

Right... the difficult part of psychopharm is making a DSM-IV diagnosis... not understanding all that simplistic neurobiology, cytochrome p450 interactions, or the multiple psychiatric presentations of medical illness.

What makes you think that existing postdoctoral training programs in clinical psychopharmacology, requisite practica, and physician-supervised conditional prescribing practices do not cover these and related topics sufficiently? Have you looked at the recommended training curriculum? It is much more extensive than exisiting nurse practitioner programs. Psychiatrists in Tennessee have acknowledged this in legislative sessions.

The real question here is the following: Is medical school the only way to learning how to treat psychopharmacologically in a safe and effective manner? PA and NP programs suggest that it is not. This leads to another question: How can psychologists be trained to treat psychopharmacologically in a safe and effective manner? What level of training is required for one to become competent in psychopharmacologic care? Medical school is clearly not the only route.

What is psychiatry doing to address the access to care problem in the United States? Sure, as Anasazi pointed out above, there has been an increase in the number of medical graduates entering psychiatry residencies. But this still does not meet the needs of most states, where behavioral healthcare remains fragmented and disorganized.

Maybe instead of going to drug dinners, psychiatrists should make an effort to increase recruitment of US medical graduates into psychiatry. As it stands, psychiatry is one of the lowest paying medical specialties. The majority of US medical students scratch this specialty off their list once they do their inpatient psychiatry rotation.

 

[Poety]

What makes you think that existing postdoctoral training programs in clinical psychopharmacology, requisite practica, and physician-supervised conditional prescribing practices do not cover these and related topics sufficiently? Have you looked at the recommended training curriculum? It is much more extensive than exisiting nurse practitioner programs. Psychiatrists in Tennessee have acknowledged this in legislative sessions.

The real question here is the following: Is medical school the only way to learning how to treat psychopharmacologically in a safe and effective manner? PA and NP programs suggest that it is not. This leads to another question: How can psychologists be trained to treat psychopharmacologically in a safe and effective manner? What level of training is required for one to become competent in psychopharmacologic care? Medical school is clearly not the only route.

What is psychiatry doing to address the access to care problem in the United States? Sure, as Anasazi pointed out above, there has been an increase in the number of medical graduates entering psychiatry residencies. But this still does not meet the needs of most states, where behavioral healthcare remains fragmented and disorganized.

Publichealth - are you a medical student or a psychology student? I know you say you're going to go to medical school, but I'm starting to think you're actually in a psychology program - you post a lot on the psychology forum as well, and I'm just wondering if you're misrepresenting yourself.

 

[PublicHealth]

Publichealth - are you a medical student or a psychology student? I know you say you're going to go to medical school, but I'm starting to think you're actually in a psychology program - you post a lot on the psychology forum as well, and I'm just wondering if you're misrepresenting yourself.

I'm an MSII at NYCOM who is concerned about the future of behavioral healthcare in this country. I support RxP for psychologists because psychiatry as a profession has done little to address the access to care problem in the US. I have friends in clinical psychology training programs who incessantly complain about how difficult it is to get an appointment with a psychiatrist (especially child psychiatrist). Many pediatricians and adolescent medicine physicians do not want to treat kids with psychiatric disorders. Child psychiatrists in the area are over-booked. I have heard 8-12 month waitlists.

 

[Poety]

I'm an MSII at NYCOM who is concerned about the future of behavioral healthcare in this country. I support RxP for psychologists because psychiatry as a profession has done little to address the access to care problem in the US. I have friends in clinical psychology training programs who incessantly complain about how difficult it is to get an appointment with a psychiatrist (especially child psychiatrist). Many pediatricians and adolescent medicine physicians do not want to treat kids with psychiatric disorders. Child psychiatrists in the area are over-booked. I have heard 8-12 month waitlists.

The need is real - but why wouldn't you be encouraging medical doctors to prescribe? I understand the need, but I think getting more people to go into psychiatry would be more beneficial than having midlevels prescribe drugs with such deleterious side effects if mismanaged dont you think? If you're in med school, then you know EXACTLY what I'm talking about - no?

 

[Anasazi23]

What makes you think that existing postdoctoral training programs in clinical psychopharmacology, requisite practica, and physician-supervised conditional prescribing practices do not cover these and related topics sufficiently? Have you looked at the recommended training curriculum? It is much more extensive than exisiting nurse practitioner programs. Psychiatrists in Tennessee have acknowledged this in legislative sessions.

In the practica for psychologists to prescribe, they are not, in most cases, supervised by psychiatrists. "Requisite practica" in psychology prescription training is akin to going to a ski instructor for tennis lessons. The training will therefore be way below par. Par in this case is psychiatry residency.

The real question here is the following: Is medical school the only way to learning how to treat psychopharmacologically in a safe and effective manner? PA and NP programs suggest that it is not. This leads to another question: How can psychologists be trained to treat psychopharmacologically in a safe and effective manner?

There is an "institution" of medicine. There is a deep-rooted training protocol that dates back centuries of learning the medical model. You can either do this in the established way to understand and appreciate the nature of the human condition and its diseases, or attend the equivalent of a crash course where the discipline, work, and evaluation of competency (PEP is nonsense) is had.

What level of training is required for one to become competent in psychopharmacologic care? Medical school is clearly not the only route.

Maybe not. But it is the best way. This is true regardless of outcome data. You cannot test what could never have been known. Think of the logistics.

What is psychiatry doing to address the access to care problem in the United States? Sure, as Anasazi pointed out above, there has been an increase in the number of medical graduates entering psychiatry residencies. But this still does not meet the needs of most states, where behavioral healthcare remains fragmented and disorganized.

Educate yourself by looking at the APA website, and notice the myriad initiatives being targeted at medical students which effectively market the profession to doctors in training.
To say nothing is being done is false.
[/quote]
Maybe instead of going to drug dinners, psychiatrists should make an effort to increase recruitment of US medical graduates into psychiatry. As it stands, psychiatry is one of the lowest paying medical specialties. The majority of US medical students scratch this specialty off their list once they do their inpatient psychiatry rotation.[/QUOTE]
1. See above.
2. I'm allowed to go to drug dinners. You can actually learn something there.
3. What the hell does pay have to do with anything?
By your own argument, psychologists prescribing which will lower psychiatrist pay will further hamper it's attractiveness, no?

P.S. There will always be room in the market for physician-level mental health care. Psychologists have been fighting since the 1970's to ENFORCE rules such as attending status in hospitals. This has continually failed due essentially to their lack of medical training and non-physicianhood status. You cannot be solely responsible for a patient's care if you are not a physician, capable of writing for any and all treatments, and using your medical license in its most effective way.

 

[sasevan]

The need is real - but why wouldn't you be encouraging medical doctors to prescribe? I understand the need, but I think getting more people to go into psychiatry would be more beneficial than having midlevels prescribe drugs with such deleterious side effects if mismanaged dont you think? If you're in med school, then you know EXACTLY what I'm talking about - no?

Hi Poety,
Please try to keep an open mind about psychologists and RxP-which may be easier said than done given the tedency to either bait or belittle the other side on this issue.
Some clarifications:
1. PhD/PsyD are doctors; not physicians, not medical doctors, not osteopathic doctors, but doctors nonetheless.
2. PhD/PsyD are not mid-level mental health providers in psychodiagnostic evaluations or psychometric testing or psychotherapeutic interventions. Psychologists are arguably better trained than any other mental health providers in those areas; though obviously not in psychopharmacolgy.
3. I highly value MD/DO and always refer my patients to psychiatrists for med eval/mgm, instead of to a PCP, since they (and one day, hopefully I) are the medical specialists in this area and because, in my experience, many PCP give antidep and antianx meds with too little apparent attention to symptomatology, eg a PCP recently rx Xanax as the only med to a patient with MDD (pt has no other med conition). I think it would be far better for a psychiatric pt to be treated pharmacologically by a med psychologist than by a PCP.
Peace.

 

[PsychEval]

Am I the only person that finds this unbelievably sleazy and borderline unethical?

Funny how this unscientific survey fails to mention that anyone can receive psychiatric treatment by simply walking into their local friendly ER. There, they are often treated and released, admitted, and referred to the hospital-affiliated clinic.

Did they bother calling the local psychiatric clinics (university and private) to ask them how long it would take to get an appointment? Or did they find that the pilot study's findings that many clinics take walk-ins didn't appeal to their study results? My money's on the latter.

They have yet to produce a study showing that psychologists are moving to underserved areas. This will be the downfall of further privilage rights, when the American Psychiatric Association proves that they're basically lying about their altruistic intentions.

This is great....as psychologists who understand research design, I'm sure they got a control or comparison group of their own profession. I'll just wait here for that data....

....
....

Hmm....

Ah well, I'm off to another drug dinner. This one's by Janssen for Risperdal Consta at one of my favorite restaurants. Nice to be at the top of the food chain.

*pardon the pun*

A profession that fails to meet the needs of society, and ATTEMPTS to prohibit another profession from assisting seems unethical.

I don’t think a $1,000 visit to the ER (usually at the tax payers expense) is appropriate to manage outpatient psychiatric needs. You are in health care, right?

 

[Doc Samson]

The majority of US medical students scratch this specialty off their list once they do their inpatient psychiatry rotation.

The majority of US medical students scratch surgery off their list once they've done their rotation... do psychologists want to learn how to suture?

 

[Doc Samson]

Is medical school the only way to learning how to treat psychopharmacologically in a safe and effective manner? PA and NP programs suggest that it is not. This leads to another question: How can psychologists be trained to treat psychopharmacologically in a safe and effective manner? What level of training is required for one to become competent in psychopharmacologic care? Medical school is clearly not the only route.

So here's an admission:

After 4 years of pre-med and an undergraduate degree in Biology, a Master's in physiology, 4 years of medical school, and 3.5 years of psychiatry residency, when I read the reports in psychopharm journals they're still difficult to interpret. Sometimes I have to re-read the article a few times. Sometimes I go ask my superviors for their thoughts. Psychopharm isn't easy, and I don't think you can learn the equivalent of 12 years of scientific training by reading the Cliff's notes.

 

[PsychEval]

The majority of US medical students scratch surgery off their list once they've done their rotation... do psychologists want to learn how to suture?

I suspect, just like most psychiatrists, the majority of psychologists probably are not interested in suturing. However, psychologists are learning how to conduct physical exams, neurological exams, etc.

 

[50960]

I can suture!! Why the hell would I want to though?? Nurses do that.

 

[john182]

I think it would be far better for a psychiatric pt to be treated pharmacologically by a med psychologist than by a PCP.
Peace.

Until there are large RCTs and subsequent meta-analyses, it's purely speculation.

I see a lot of requests for training recognition here, courses, pharm teaching, etc., etc., . They are all just bull**** training courses as usual (heck why not even throw in an MBA!).

Until all stakeholders sit down and do many trials of the necessary outcomes to warrant non-physician prescribing in psychopharamcology, it's like becoming a fully-fledged specialist after graduating medical school (i.e., you know almost nothing of the real world).

So, where are these trials? Who is funding them? Besides advocacy groups, there appears to be very little evidence base.

Actually: I do remember one study by the US military - the Psychopharmacology Demonstration Project. It showed that psychologists could be taight to prescribe at an equivalent level: here is the final report, which you won't see on the AMerican Psychological Associations website (except to say that the PDP showed psychology prescribing was shown to be as good as that by medical doctors after training)

ISSUE: Should Congress accept the U.S. Government Accounting Office’s (GAO) congressionally requested report on the DOD Psychopharmacology Demonstration Project (PDP) to train psychologists to prescribe medication? GAO stated, “given PDP’s substantial costs and questionable benefits . . . we see no reason to reinstate this demonstration project.”

BACKGROUND: In August 1991, at Senator Daniel Inouye’s (D-HI) behest, the Department of Defense began a controversial program to increase the scope of practice of clinical psychologists in the military so they could independently treat patients with psychotropic medication. Recruitment has been difficult, and only 13 psychologists have participated in the program since 1991 (the goal was 6 psychologists per yearly PDP class, making a target of 30 psychologists from each of the program years 1991-1995). Of the 13 participants in the PDP, 7 completed it and 3 dropped out. Of the drop-outs, one left to go to medical school, one left because of dissatisfaction with the program itself, and the other left the military altogether. The other three -- two of which were recruited from the civilian population because of a lack of interest among military clinical psychologists -- will finish the program in June 1997. According to the GAO, the costs associated with the program have exceeded $6 million, or about $610,000 per psychologist. Public Law 104-106 terminated the program effective June 30, 1997. The law, the National Defense Authorization Act for FY 1996, also required the GAO, the federal government’s independent watchdog agency, to submit a report evaluating the success of the PDP program and recommending whether or not the program should be reinstated.

APA POSITION: The GAO Report rightly states, “because medical training is not required to practice clinical psychology, psychologists are not qualified to prescribe medication,” rightly points out that “clinical psychologists practice psychology, not medicine,” and rightly asserts that “psychologists cannot be substituted for psychiatrists.” Further, GAO states that “the MHSS (military health services system) needs no prescribing psychologists or any other additional mental health providers authorized to prescribe psychotropic medication.”

The GAO concludes that “given DOD’s readiness requirements, the PDP’s substantial cost and questionable benefits, and the project’s persistent implementation difficulties, we see no reason to reinstate this demonstration project.”

Congress should not provide any funding source to continue any program to train clinical psychologists to prescribe medications.

At $610,000, it would be cheaper and quicker to send them all to medical school in Harvard.

 

[Poety]

Hi Poety,
Please try to keep an open mind about psychologists and RxP-which may be easier said than done given the tedency to either bait or belittle the other side on this issue.
Some clarifications:
1. PhD/PsyD are doctors; not physicians, not medical doctors, not osteopathic doctors, but doctors nonetheless.
2. PhD/PsyD are not mid-level mental health providers in psychodiagnostic evaluations or psychometric testing or psychotherapeutic interventions. Psychologists are arguably better trained than any other mental health providers in those areas; though obviously not in psychopharmacolgy.
3. I highly value MD/DO and always refer my patients to psychiatrists for med eval/mgm, instead of to a PCP, since they (and one day, hopefully I) are the medical specialists in this area and because, in my experience, many PCP give antidep and antianx meds with too little apparent attention to symptomatology, eg a PCP recently rx Xanax as the only med to a patient with MDD (pt has no other med conition). I think it would be far better for a psychiatric pt to be treated pharmacologically by a med psychologist than by a PCP.
Peace.

Hi Sas,

Points well taken - I am just a bit against prescribing by anyone that is not a physician if you must know the truth. This goes with talks I've given to other specialties as well - I am personally very much against it. (This also includes NP's, PA's and the like) I understand completely the need for them to be there, but I don't think they have enough training or understanding to competently prescribe - and this comes from experience in the medical field so my ideas are deeply instilled (unfortuntely at the expense of patients I had that ultimately suffered the consequences)

I'm also not saying that these people COULDN'T prescribe - in all honesty - if they can take the step 1,2 and 3, and PASS and obtain a medical license - then I say let em prescribe. That would go along with being competent enough to do so. This is what I would argue to PH about - if he thinks that all these people can take a different avenue to achieve the same goal - then I say, let them get a medical license as well like the docs so that there is no question on their ability ya know?

 

[Anasazi23]

A profession that fails to meet the needs of society, and ATTEMPTS to prohibit another profession from assisting seems unethical.

I don't think a $1,000 visit to the ER (usually at the tax payers expense) is appropriate to manage outpatient psychiatric needs. You are in health care, right?

Nice try, but the question was about access to care. The ER is one route of access, and often not a bad place to start, as medical causes can be ruled out on acute presentations. Floridly violent psychotic people don't pick up the phone looking for psychiatrist appointments.

Since most of my points weren't addressed, I'll reiterate: Did they bother to call local psychiatric clinics, either university, hospital, private, or state run?

It would likely take just as long to get a private rheumatology or dermatology appointment. To single-out private office psychiatrists may have been the wrong way to go. Also, where is the comparitive psychologist survey findings? Then again, these results are likely incomparable since their services are in some ways, less desirable from a marketing standpoint.

 

[PsychEval]

Nice try, but the question was about access to care. The ER is one route of access, and often not a bad place to start, as medical causes can be ruled out on acute presentations. Floridly violent psychotic people don't pick up the phone looking for psychiatrist appointments.

Since most of my points weren't addressed, I'll reiterate: Did they bother to call local psychiatric clinics, either university, hospital, private, or state run?

It would likely take just as long to get a private rheumatology or dermatology appointment. To single-out private office psychiatrists may have been the wrong way to go. Also, where is the comparitive psychologist survey findings? Then again, these results are likely incomparable since their services are in some ways, less desirable from a marketing standpoint.

I don’t know, not everyone is looking for a bi-polar diagnosis and 4 medications.

 

[PublicHealth]

Since most of my points weren't addressed, I'll reiterate: Did they bother to call local psychiatric clinics, either university, hospital, private, or state run?

It would likely take just as long to get a private rheumatology or dermatology appointment. To single-out private office psychiatrists may have been the wrong way to go. Also, where is the comparitive psychologist survey findings? Then again, these results are likely incomparable since their services are in some ways, less desirable from a marketing standpoint.

These are certainly limitations. Who knows what kinds of data the psychologists in California have compiled. They have kept this lawsuit VERY quiet over the years and only now have they made it public that it was filed. I'm sure they have at least some of their cards in order.

 

[Harmony]

These are certainly limitations. Who knows what kinds of data the psychologists in California have compiled. They have kept this lawsuit VERY quiet over the years and only now have they made it public that it was filed. I'm sure they have at least some of their cards in order.

Who actually have filed the lawsuit? Are the plaintiffs psychologist themselves or the plaintiffs have reached the psychologist to file the lawsuit on their behalf? If later is true then what is the credibility of the lawsuit? Not that I am an expert but does not seem to hold a lot of weight. Additionally, is there a law against people presenting wrong/misleading data?

For the record, I am neither a psychologist or psychistrist.

 

[PublicHealth]

Who actually have filed the lawsuit? Are the plaintiffs psychologist themselves or the plaintiffs have reached the psychologist to file the lawsuit on their behalf? If later is true then what is the credibility of the lawsuit? Not that I am an expert but does not seem to hold a lot of weight. Additionally, is there a law against people presenting wrong/misleading data?

For the record, I am neither a psychologist or psychistrist.

Not sure of the specifics. Edieb in the clinical psychology forum may know.

 

[50960]

I don't know much about the lawsuit either. However next time the psychology mafia subcommittee to overthrow psychiatry meets I will provide more information.............

 

[Anasazi23]

[/B]

I don’t know, not everyone is looking for a bi-polar diagnosis and 4 medications.

Don't exaggerage. I diagnosis all my patients with schizoaffective disorder and start them on no less than 6 medications.

 

[edieb]

Since there are only 4-5 prescriping psychologists in New Mexico and at least one of them is in a very rural area (Los Cruces is in the middle of nowhere), it looks like clinical psychologists are reaching persons in remote areas. Also, read the excerpt about the difficulty reaching a patient's psychiatrist and how Dr. Levine stepped in and saved the day.from the evil psychiatrist!

--------------------------------------------------------------------------------

http://www.division42.org/MembersAr...prescribing.php

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I wasn't going to dignify this obvious bait with a reply, but I'll let my worse judgement get the best of me. Being on-duty for over 24 hours now with no sleep probably has something to do with it.

The only solution to the above problem (clearly manipulated by unscrupulous psycologists) is to give you, psisci, prescription privilages so that you can work in the California prison system.

As is evident in the deserts of new mexico and the swamps of louisiana, the psychologists love to flock there - true to their words that they are concerned about patient care.

Good luck to you. I'm sure you'll love the prison system.

 

[50960]

Las Cruces is actually a fairly good sized town that houses NMSU. New Mexico is the middle of nowhere, but as far as that goes LC is not rural.

 

[edieb]

Los Cruces is VERY small, dude.

 

[Poety]

No one replied to my suggestion of psych Rxp taking the steps - what is that a bad idea?

 

[50960]

Los Cruces may be, but Las Cruces isn't by NM standards. NMSU has over 30,000 students. I have been there many times, my wife is from NM, and did her PhD at NMSU.

 

[Anasazi23]

I love the fact that this thread got hijacked into whether or not Los Cruces is a big or little city. The beauty of the internet.

Anyway, there appears to be something wrong with my PMs. So Psisci, I can talk of Risperdal Consta here.

The question as it's efficacy really depends on the patient. Not everyone is a candidate for Risperdal, and it seems to work better on some patient types than others. Of course, the three week lag which requires oral supplementation leaves the question as to what 'did the trick' if it's initial therapy. For stable patients already on risperdal, however, it seems to keep them stable in my experience. Then again, most psychiatric patients that require depots tend to be sicker, more relapsing folks.

I'm looking forward to other atypical depot formulations as well. The q 2 week injections seem to be a good starting point, but those two weeks go fast. A month would be nicer in some cases. Then again, adverse reactions make us nervous when we cannot hasten the elimination of the drug.

 

[sasevan]

No one replied to my suggestion of psych Rxp taking the steps - what is that a bad idea?

I'm willing to consider it; ultimately for me it is about providing patients with increased access to mental health doctors who are competent, efficient, and ethical pharmacologists.
But I do have a question re the Steps (please remember I'm only pre-med):
wouldn't step 3 suffice? or better yet, the psychiatry boards?
Peace.

 

[Solideliquid]

I'm willing to consider it; ultimately for me it is about providing patients with increased access to mental health doctors who are competent, efficient, and ethical pharmacologists.
But I do have a question re the Steps (please remember I'm only pre-med):
wouldn't step 3 suffice? or better yet, the psychiatry boards?
Peace.

PH and PE keep saying there will be some sort of examinations for RxP psychologists. I am very much in favor of any psychologists having to take Step 1 2 and 3 as they are required for medical students to practice medicine. And no, Step 3 alone would not be enough.

Step 3 tests if you can practice medicine without supervision among other things, but steps 1 and 2 are very necessary. Step 1 tests on the basic sciences, and step 2 on the clinical aspect of medicine although there is some overlap. Step 2 CS tests your physical exam skills.

PH- when are you taking step 1? After you take it and if you pass please let us know if your views have changed. I know after I passed step 1 I started to feel like I really belonged in the medical family and I was started to feel very proud of being sort of accepted into the medical insitution. Step 1 is a big hurdle, in my opinion the most difficult of the USMLEs.

 

[PsychEval]

No one replied to my suggestion of psych Rxp taking the steps - what is that a bad idea?

I'm also not saying that these people COULDN'T prescribe - in all honesty - if they can take the step 1,2 and 3, and PASS and obtain a medical license - then I say let em prescribe. That would go along with being competent enough to do so. This is what I would argue to PH about - if he thinks that all these people can take a different avenue to achieve the same goal - then I say, let them get a medical license as well like the docs so that there is no question on their ability ya know?[/B]

The same could be said of psychotherapy. If psychiatrists take psychology orals, qualifying exams, and Pass the EPPP and become licensed as a psychologist, then I say let em conduct psychotherapy.

As we know, most psychiatrists are not appropriately trained to conduct psychotherapy. As pointed out by Chelsea Chesen, M.D., a second year house officer in the Creighton-Nebraska Psychiatry Residency Program, started her residency with a keen focus on psychopharmacology but soon realized that it wasn’t going to be enough. After she started seeing patients she realized that there were necessary skills that she didn’t possess from her training. Chesen said, You realize that things pop up that can be very messy and overwhelming and frustrating, and all of your past training in medical school is poor preparation for handling those moments. For Chesen, one of those moments occurred when a patient carried a shopping bag full of psychotherapy books up eight flights of stairs to a session, emptied it onto the table and said, You might want to have these books.

Psychiatric Times, July 1999, Vol XVI, Issue 7.

 

[Solideliquid]

As we know, most psychiatrists are not appropriately trained to conduct psychotherapy. As pointed out by Chelsea Chesen, M.D., a second year house officer in the Creighton-Nebraska Psychiatry Residency Program, started her residency with a keen focus on psychopharmacology but soon realized that it wasn’t going to be enough. After she started seeing patients she realized that there were necessary skills that she didn’t possess from her training. Chesen said, You realize that things pop up that can be very messy and overwhelming and frustrating, and all of your past training in medical school is poor preparation for handling those moments. For Chesen, one of those moments occurred when a patient carried a shopping bag full of psychotherapy books up eight flights of stairs to a session, emptied it onto the table and said, You might want to have these books.

Psychiatric Times, July 1999, Vol XVI, Issue 7.

Fortunately, psychotherapy training is on the rise in psychiatry programs now. In fact during most of my interviews everyone I spoke with was glad to hear my interest in psychotherapy as well as letting me know the minimum requirements for psychotherapy training in psychiatry residency has been elevated recently so now all psychiatry programs need to focus on psychotherapy more than in recent years.

And I kind of think that 4 years or more in psych residency can provide more than ample training in psychotherapy, so we don't have to take more than the psych boards after residency.

 

[PsychEval]

Fortunately, psychotherapy training is on the rise in psychiatry programs now. In fact during most of my interviews everyone I spoke with was glad to hear my interest in psychotherapy as well as letting me know the minimum requirements for psychotherapy training in psychiatry residency has been elevated recently so now all psychiatry programs need to focus on psychotherapy more than in recent years.

And I kind of think that 4 years or more in psych residency can provide more than ample training in psychotherapy, so we don't have to take more than the psych boards after residency.

According to COPP chair Norman A. Clemens, M.D., while many residency programs offer exposure to CBT, psychodynamic and supportive therapies, residents are not adequately prepared to competently use them to treat patients.

I'm glad to hear that Chelsea and Norman are wrong, and that things are getting better.

It is not the role of a psychology licensing board to determine what is appropriate training for psychiatrists. Psychiatrists can work those issues out on their own. Similarly, it is not the role of psychiatry to determine what is appropriate training for psychologists.

Viva California!