Why cant psychologists write prescriptions?

[Anuwolf]

I’ve been going to shrinks and therapists for such a long time (Quit about few years ago) that I still cannot understand why psychiatrists are able to write scripts and not psychologists. All of the psychiatrists that I’ve seen never allowed me to express my feelings without them telling me to take it up to my therapist. They always want to hear my symptoms and the kind of side effects that I’m getting from the medication that I was taking at the time of my visit. How can they treat my problems without having to hear what I say? Not to mention my life story. How can a psychiatrist sit there and tell me that I have a chemical imbalance when they don’t want to hear my life story?

I’ve notice that the laws are changing over the past couple of years. In few states such as Louisiana allows licensed psychologists (who have PhD) to write scripts. I hope one day that the laws would make it so that psychologists could have the authorization of writing scripts for anti depression, anti psychotics, anti anxiety/panic attacks, etc.

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[50960]

It is just law...health and safety code. I know many psychologists in Ca who write Rx's daily cosigned by a NP/PA/MD. The law is just in the way from reality.....

 

[PublicHealth]

How can a psychiatrist sit there and tell me that I have a chemical imbalance when they don’t want to hear my life story?

Because they can make three times as much money doing three med checks in one psychotherapy hour. Also, managed care tells them that they should provide psychotropics and that others (PhDs, MSWs) should provide therapy.

 

[SoCuteMD]

I’ve been going to shrinks and therapists for such a long time (Quit about few years ago) that I still cannot understand why psychiatrists are able to write scripts and not psychologists.

Because psychiatrists have been to medical school, completed neuroscience, pathology, pharmacology successfully and received either an MD or a DO degree. Psychologists have only done SOME of the above.

 

[PublicHealth]

Because psychiatrists have been to medical school, completed neuroscience, pathology, pharmacology successfully and received either an MD or a DO degree. Psychologists have only done SOME of the above.

Umm, you forgot psychiatry residency. Didactics are a small part of the battle.

Apples and oranges. You're comparing two different models of training. NPs and PAs prescribe psychotropics and other drugs every day, some NPs even do so independently. Optometrists, dentists, and podiatrists don't have the coveted MD or DO degree and they prescribe as well. Stop being so elitist. Flexner is dying.

 

[Dr Trek 1]

Umm, you forgot psychiatry residency. Didactics are a small part of the battle.

Apples and oranges. You're comparing two different models of training. NPs and PAs prescribe psychotropics and other drugs every day, some NPs even do so independently. Optometrists, dentists, and podiatrists don't have the coveted MD or DO degree and they prescribe as well. Stop being so elitist. Flexner is dying.

I don't think this debate will ever stop.

Facts:

1) Dentists, optometrists, podiatrists, chiropractors, etc. are limited to what they can prescribe. Specifics vary by state.
2) NPs/PAs are also limited in what they can prescribe without being cosigned by a MD/DO, but not as much as the above professions. Specifics vary by state.
3) Psychiatrist residents (MD/DO) are well supervised and well qualified to write scripts for psychotropic medications.

 

[ProZackMI]

I don't think this debate will ever stop.

Facts:

1) Dentists, optometrists, podiatrists, chiropractors, etc. are limited to what they can prescribe. Specifics vary by state.
2) NPs/PAs are also limited in what they can prescribe without being cosigned by a MD/DO, but not as much as the above professions. Specifics vary by state.
3) Psychiatrist residents (MD/DO) are well supervised and well qualified to write scripts for psychotropic medications.

Actually, in ALL states, dentists and podiatrists have unlimited Rx privis...but of course, would an Rx for psychotropics get filled if written by a DPM or DDS? Not sure, but some psychotropics have been used to treat neuropathic pain, etc. (Elavil). I think optometrists have very, very limited RxPs. Chiros CANNOT Rx anything under any circumstances. PharmDs in some states have RxPs under MD/DO protocols. All NPs and PAs have to Rx under an MD/DO protocol even though many NPs don't have to have everything approved by a supervising MD/DO, they are required to work under a collaborative protocol.

 

[Anuwolf]

Because psychiatrists have been to medical school, completed neuroscience, pathology, pharmacology successfully and received either an MD or a DO degree. Psychologists have only done SOME of the above.

I understand but how can they tell people that they have chemical imbalance without doing any kind of additional tests such as CAT/MRI scans or some blood tests done? How can you tell if somebody has an imbalance just by talking to them? All of the psychiatrists that I’ve seen NEVER ordered either a CAT/MRI scans or any kind of blood work done on me, other then the times when I was taking medication (Lithium) that’s known to cause kidney damage.

 

[Dr Trek 1]

I understand but how can they tell people that they have chemical imbalance without doing any kind of additional tests such as CAT/MRI scans or some blood tests done? How can you tell if somebody has an imbalance just by talking to them? All of the psychiatrists that I’ve seen NEVER ordered either a CAT/MRI scans or any kind of blood work done on me, other then the times when I was taking medication (Lithium) that’s known to cause kidney damage.

This brings up endless issues.

 

[50960]

I agree with you. However, it is not the physician's fault.

CTs and MRIs are incredibly expensive and many insurance companies will not pay for them just to make sure lithium isn't doing any damage. There needs to be more probable cause- i.e. symptoms of some type of liver problems. However, with the small dosages most people are on for lithium, there is typically nothing to worry aobut.

Are you in Med school yet? We know li+ will cause hyothyroidism over time, and there is a big concern for renal function as well as toxicity.......

 

[Dr Trek 1]

Are you in Med school yet? We know li+ will cause hyothyroidism over time, and there is a big concern for renal function as well as toxicity.......

No I am not yet a medical student.

Sure, lithium can cause harm over time. All I was trying to explain is how healthcare justifies not giving medical tests (CTs, MRIs, etc) unless they are absolutely necessary. A patient who has been on lithium for a while and shows no signs of liver or thyroid trouble is unfortunately not considered "absolutely necessary" and most insurances would not cover it.

I am not saying I agree with it. It's just the way things are.

 

[Psyclops]

However, with the small dosages most people are on for lithium, there is typically nothing to worry aobut.

Have you had much experience with clinical populations? Have you seen what Li toxicity looks like? How about Dystonia? Akanesia? Akathesia? What about the very real concern of agranulocytosis associated with clozapine? I don't think you can imagine the weight gain associated with valproic acid and other drugs. Or the constantly high bezo patient. Li toxicity is soemthing to worry about. That's why MDs take blood tests and monitor for it.

In response to the OP (and to DR. Trek), the reason they don't do blood tests, or MRI or CT scans is that they don't tell you anything. As of yet there has been no lab test found that can reliably indicate whether someone suffers from a mental disorder.

 

[SoCuteMD]

I understand but how can they tell people that they have chemical imbalance without doing any kind of additional tests such as CAT/MRI scans or some blood tests done? How can you tell if somebody has an imbalance just by talking to them? All of the psychiatrists that I’ve seen NEVER ordered either a CAT/MRI scans or any kind of blood work done on me, other then the times when I was taking medication (Lithium) that’s known to cause kidney damage.

It is clear from your post on here as well as your posts in other forums that you simply don't know medicine or the basic science behind it. And that's ok, but please understand that these forums are primarily intended for people in these fields.

"Tests" for chemical imbalances diagnosed by psychiatrists would require brain biopsy and expensive molecular tagging and imaging. Did you watch House last week? Did you see how reluctant they were to do a brain biopsy even when there was a life on the line? Yeah...that part wasn't made up. Frankly, the trial and error with medication and therapy is MUCH MUCH cheaper and safer.

As far as the "why can't clinical psychologists prescribe" question, please understand that I was making a valid point. Psychotropic drugs are a BIG deal (I honestly think that many psychiatrists/physicians underestimate their significance), frankly there is a lot more danger IN GENERAL in mistreating a psychiatric patients than one can do with a dose of antibiotics. If and when strong clinical oversight, and thorough basic science education in neuroscience, pharmacology, and pathology is established in clinical psychology programs in such a way that it is regulated (much like undergraduate medical education is regulated) then I will be the FIRST one to advocate for prescription privileges for anyone who has completed such a program.

As it is, I believe there are enough people dispensing these drugs and frankly the world really needs more people doing therapy (psychiatrists included!) than it does people writing prescriptions!!! (sorry, this is not eloquently phrased...I just don't have the time right now!)

 

[PublicHealth]

If and when strong clinical oversight, and thorough basic science education in neuroscience, pharmacology, and pathology is established in clinical psychology programs in such a way that it is regulated (much like undergraduate medical education is regulated) then I will be the FIRST one to advocate for prescription privileges for anyone who has completed such a program.

http://www.rxpsychology.com/crsstudy.htm

 

[Poety]

I’ve been going to shrinks and therapists for such a long time (Quit about few years ago) that I still cannot understand why psychiatrists are able to write scripts and not psychologists. All of the psychiatrists that I’ve seen never allowed me to express my feelings without them telling me to take it up to my therapist. They always want to hear my symptoms and the kind of side effects that I’m getting from the medication that I was taking at the time of my visit. How can they treat my problems without having to hear what I say? Not to mention my life story. How can a psychiatrist sit there and tell me that I have a chemical imbalance when they don’t want to hear my life story?

I’ve notice that the laws are changing over the past couple of years. In few states such as Louisiana allows licensed psychologists (who have PhD) to write scripts. I hope one day that the laws would make it so that psychologists could have the authorization of writing scripts for anti depression, anti psychotics, anti anxiety/panic attacks, etc.

Because psychiatrists can't listen to it all as well as psychologists - we're trained differently, and they forgot our touchy feely classes so our tolerance level is lower

SORRY PSICI. I couldn't resist this one.

 

[Dr Trek 1]

Because psychiatrists can't listen to it all as well as psychologists - we're trained differently, and they forgot our touchy feely classes so our tolerance level is lower

SORRY PSICI. I couldn't resist this one.

I know your post was meant to be tongue-in-cheek, but don't forget about the psychiatrists who do indeed have a clinical psychology/counseling background (like I will have when I am a psychiatrist).

 

[Poety]

I know your post was meant to be tongue-in-cheek, but don't forget about the psychiatrists who do indeed have a clinical psychology/counseling background (like I will have when I am a psychiatrist).

Then you'll get to roll in the big bank since you can do a fee for service and enjoy the chatter

TOtally tongue in cheek btw

 

[50960]

Poety consider yourself smacked!!!

 

[coloradocutter]

Money, money, money. It is ironic that that is all I see in this friendly jabbing between the Ph.D.s and the M.D.s. I have a secret to tell you. If you would have gone to a top 10 law school and working at a big law firm, you would be starting out at the age of 24 (if you went straight through) at somewhere around $150K or so. By the age of 30, you would be approaching $300K. (Now, these amounts are only at really large firms, usually east coast/west coast large cities).

But, guess what, you'd likely be extremely miserable. I went to a top law school on scholarship and had no debt. It was like having a license to steal. Making six figures when I was barely 24 years old, but I was not happy.

So, you guys stop fighting about money. The winner here is whoever likes what they do. To me, prescribing meds all day would be mind-numbingly boring, but therapy might make many cringe. It takes all of us and all of our talents. I think the statistics are that after you reach around $50K or so, money does not correlate with happiness - so the question is what will you be happier doing? If you are happier doing psychiatry and the other is happier with psychology, be happy and move on. Geesh, this whole health profession snoberry thing is a little frightening. I have worked in that kind of industry - just because I have a law degree and a license, I get a secretary, a paralegal, a parking space, and all kinds of perks. My paralegal knows more than I do and still does! So stupid.

And, the prescribing issue - if the state legislature thinks that a Ph.D. should be prescribing medicines, then they should and they will. It seems like it is coming in other states, but why should the shrinks care - I don't know any therapists that want to do med management all the time. They do therapy because that is what they want to do!

 

[positivepsych]

Money, money, money. It is ironic that that is all I see in this friendly jabbing between the Ph.D.s and the M.D.s. I have a secret to tell you. If you would have gone to a top 10 law school and working at a big law firm, you would be starting out at the age of 24 (if you went straight through) at somewhere around $150K or so. By the age of 30, you would be approaching $300K. (Now, these amounts are only at really large firms, usually east coast/west coast large cities).

But, guess what, you'd likely be extremely miserable. I went to a top law school on scholarship and had no debt. It was like having a license to steal. Making six figures when I was barely 24 years old, but I was not happy.

So, you guys stop fighting about money. The winner here is whoever likes what they do. To me, prescribing meds all day would be mind-numbingly boring, but therapy might make many cringe. It takes all of us and all of our talents. I think the statistics are that after you reach around $50K or so, money does not correlate with happiness - so the question is what will you be happier doing? If you are happier doing psychiatry and the other is happier with psychology, be happy and move on. Geesh, this whole health profession snoberry thing is a little frightening. I have worked in that kind of industry - just because I have a law degree and a license, I get a secretary, a paralegal, a parking space, and all kinds of perks. My paralegal knows more than I do and still does! So stupid.

And, the prescribing issue - if the state legislature thinks that a Ph.D. should be prescribing medicines, then they should and they will. It seems like it is coming in other states, but why should the shrinks care - I don't know any therapists that want to do med management all the time. They do therapy because that is what they want to do!

Thank you, I agree. It's nice to hear from someone with a little outside perspective.

 

[deleted6669]

just a side note....pa's and np's have their own dea #s and do not prescribe under protocols. I have a sch 2 dea certification with only my name on it and can write for anything an md can. of course to be prudent I only rx meds within my specialty and area of experience so you won't see me writing for too many psych meds although I could.....
there is no rx for which I need an md cosignature.

 

[PublicHealth]

just a side note....pa's and np's have their own dea #s and do not prescribe under protocols. I have a sch 2 dea certification with only my name on it and can write for anything an md can. of course to be prudent I only rx meds within my specialty and area of experience so you won't see me writing for too many psych meds although I could.....
there is no rx for which I need an md cosignature.

Which is why I wonder why psychology wants to create their own prescribing model. The only reasons I can see are that (1) they eventually want independent prescriptive authority; and (2) they want a "psychological model of prescribing" that focuses on integrated psychopharmacology and psychotherapy.

 

[PublicHealth]

there is no rx for which I need an md cosignature.

Doesn't this vary by state? I find it hard to believe that you don't have to have a physician co-sign at least some percentage of your charts.

 

[deleted6669]

Doesn't this vary by state? I find it hard to believe that you don't have to have a physician co-sign at least some percentage of your charts.

chart review is not the same as cosigning scrips.
I need 10% of my charts as chosen by me cosigned within 1 month to meet the min requirement for my state(and this does vary from state to state).
I have my own dea# so this is an issue independent of practice oversight vs "having someone ok or cosign my prescriptions". the pharmacy will never know which charts were cosigned and which were not as this has nothing to do with my ability to write an rx on my own name.I could turn in the 10% of my charts every month for which no rx was written and this would still meet state regs.

 

[PublicHealth]

chart review is not the same as cosigning scrips.
I need 10% of my charts as chosen by me cosigned within 1 month to meet the min requirement for my state(and this does vary from state to state).
I have my own dea# so this is an issue independent of practice oversight vs "having someone ok or cosign my prescriptions". the pharmacy will never know which charts were cosigned and which were not as this has nothing to do with my ability to write an rx on my own name.I could turn in the 10% of my charts every month for which no rx was written and this would still meet state regs.

So you can hang out a shingle and treat patients independently, so long as 10% of your charts are signed by a licensed doctor within a month?

 

[Haqiqa]

Hey DrTrek 1 - how did you get a clinical psych/ counseling background? Did you get a degree before attending medical school? I am curious because I consider uniting the two as well.

In terms of psychologists prescribing, it is complicated - i hear that psychologists often make more accurate diagnoses than psychiatrists....however monitoring medications and being aware of drug interactions and comorbid illness is really important, and that would have to go into the psychologists' training. A person may have a thyroid imbalance, or polycystic ovarian syndrome, or many other physical problems that could cause mood disturbances, and these need to be ruled out. Think especially of older patients who are often on a mess of other medications, you need to take all of that into account when prescribing meds.

 

[Psyclops]

Dr. Trek hasn't been to med school.

 

[deleted6669]

So you can hang out a shingle and treat patients independently, so long as 10% of your charts are signed by a licensed doctor within a month?

yup- as long as I have filed the appropriate paperwork with the medical board and they have approved my supervising md(s).many rural practices are set up this way. this varies state by state. my state allows a pa to own their own practice. some states do not.some states allow a pa to own certain percentages of a practice( 33%, 40%, 49%) but not be the majority holder. I have 3 friends who work in a "33% state". 3 of them( all pa's) each own 33% of the practice and the md owns 1% and is on salary for chart review.so no pa is the max stockholder but each is an equal partner.
north carolina currently has the most relaxed supervision requirement:
supervision = 1 thirty min meeting with the supervising md every 6 months to discuss the practice.no chart review.
in california chart review is only required for interactions in which a sch 2 narcotic rx is written.
hospitals may require a more stringent standard than the state requirement. for intsance at one of my jobs the hospital requires that 100% of my charts be cosigned within 24 hrs. this still has no bearing on my ability to rx though.

 

[Dr Trek 1]

To whoever asked me, no I have not yet been to med school, but have been accepted and will be starting in the fall of 2007. Meanwhile, I will be finishing my MS in mental health counseling.