5th states passes prescriptive authority

[edieb]

Idaho Becomes Fifth State to Allow Psychologists to Prescribe Medications

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[WisNeuro]

And, cue the inevitable grumbling and empty sabre rattling due to turf protectionism!

 

[Therapist4Chnge]

That's one of the most conservative states in the country, FWIW.

 

[smalltownpsych]

That's one of the most conservative states in the country, FWIW.

I used to live up in Northern Idaho and it was an interesting mix of far right extremist militia groups and aging liberal hippies. We were about an hour from Coeur D'Alene which is a pretty nice little city.

 

[jmiah717]

As a non-psychologist, what is the general attitude amongst psychologists about this trend?

 

[WisNeuro]

As a non-psychologist, what is the general attitude amongst psychologists about this trend?

Varies pretty wildly. Among people I know, 50/50, but for different reasons. I support it in theory, but not in practice. Seems most of the programs are diploma mill in nature, only like 2 reputable sites left. Additionally, my guess is that these providers will be turned into low cost med managers instead of a multi-disciplinary mental health resource. Maybe a small proportion can do some good in a private practice setting, but any managed care setting will just abuse this.

 

[smalltownpsych]

Varies pretty wildly. Among people I know, 50/50, but for different reasons. I support it in theory, but not in practice. Seems most of the programs are diploma mill in nature, only like 2 reputable sites left. Additionally, my guess is that these providers will be turned into low cost med managers instead of a multi-disciplinary mental health resource. Maybe a small proportion can do some good in a private practice setting, but any managed care setting will just abuse this.

Agreed. Even when I survey myself, I find that the support is about 50/50.

 

[ClinicalABA]

That's one of the most conservative states in the country, FWIW.

It's also an extremely rural state, where access to care-particularly specialty providers- can be a significant barrier. I don't know if it factored into the legislation (and I don't neccesarily support it), but this might be about increasing options for patients who currently have to drive 100+ miles roundtrip to get what they need.

 

[Grenth]

It's also an extremely rural state, where access to care-particularly specialty providers- can be a significant barrier. I don't know if it factored into the legislation (and I don't neccesarily support it), but this might be about increasing options for patients who currently have to drive 100+ miles roundtrip to get what they need.

I expect the rural nature of especially rural Idaho did factor in. I have a friend who is a DMHP in NE Washington along the Idaho/Canada border and her geographic range of practice includes people who are three hours from a major hospital and the population density is 8 people per square mile. The addiction and poverty rates are very high too. I don't have an informed opinion about the Rx privileges but I can see how some would find it a good solution for places like NE Wa and N ID.

 

[st2205]

And, cue the inevitable grumbling and empty sabre rattling due to turf protectionism!

I believe we've had much more elaborate and meaningful discussions than that.

 

[WisNeuro]

I believe we've had much more elaborate and meaningful discussions than that.

Sometimes, with some posters. But it usually devolves fairly quickly. It seems to generally just be a lot of opinion, but very light on the facts/data side.

 

[Mad Jack]

And, cue the inevitable grumbling and empty sabre rattling due to concerns for patient safety!

ftfy

Many physicians that aren't psychiatrists won't touch psych meds because they're such a nightmare, even after four years of medical school and a residency. That people think they can prescribe them like it's no big deal after a brief course highlights just how little they know.

 

[WisNeuro]

ftfy

Many physicians that aren't psychiatrists won't touch psych meds because they're such a nightmare, even after four years of medical school and a residency. That people think they can prescribe them like it's no big deal after a brief course highlights just how little they know.

Meh, show me the data. If we're going to play the patient safety card, show me that the outcome data for RxP that already exists differs from more traditional prescribers.

 

[Mad Jack]

Meh, show me the data. If we're going to play the patient safety card, show me that the outcome data for RxP that already exists differs from more traditional prescribers.

It's cheap and easy to demand a study, it's hard to fund and operate one.

 

[WisNeuro]

It's cheap and easy to demand a study, it's hard to fund and operate one.

I imagine the AMA has plenty of money. Hardly a reason not to do a study if one feels it's warranted.

 

[PsyDr]

It's cheap and easy to demand a study, it's hard to fund and operate one.

There is no "unless it is inconvenient" caveat for the scientific process.

 

[st2205]

Meh, show me the data. If we're going to play the patient safety card, show me that the outcome data for RxP that already exists differs from more traditional prescribers.

I've mentioned before that if one argues for challenging the status quo, then the onus is on them to demonstrate reason for change rather than an appeal to a lack of evidence as reason for changing status quo, implying that without evidence anything goes. If we're going by the Department of Defense report, if we're calling the amalgam of interviews of people supervising and working in proximity to Rx psychologists with the lack of negative outcomes being evidence, then none of these programs resemble the Department of Defense's prescribing psychologist program.

Large swaths of clinical medicine has stemmed and arisen from a period before the dogmatic rise of Evidence Based Medicine. Would the advent of EBM nullify any of the then-contemporary beliefs and practices because it hadn't yet been published in the literature? That depends, of course. For all the practices that are still in place as conventional wisdom, should they be jettisoned until they can be proved or should they be jettisoned when they can be nullified? Things such as PSA screening and breast self-examination recommendations have changed over time as the evidence that has been interpreted to nullify the overall benefit of these has came out. Currently, there's not (yet) good evidence that colonoscopy screening reduces all cause mortality -- yet this is the current standard of care. Should this be changed before good evidence or after?

So, yes, outside of the DoD report (which no state law requirements or programs replicate), there really isn't much known about outcomes. It's easy to point this out, slapping high fives with each other knowing the other party can't put up the "proof," but it's the pot calling the kettle black. In the pattern of EBM guidelines, this leaves us with the available evidence on the pyramid being "expert opinion," which would be interesting to get different takes on what qualifies an expert. Those with the background training in medicine and who does this day-to-day largely disagree with Rx psychology. Of course, this really isn't that great of evidence. I certainly don't hold to that consensus all that strongly because it's the informal "panel of experts." But I couldn't exactly say that those who haven't been through that training and don't do it every day, such as the AP(sychological)A president, to have a very valid argument to make regarding what's prudent.

So there's a dearth of published data on the subject. Does that end the debate? Does that invalidate reasoned opinions? Do good or bad outcomes cease to exist until published? Is there evidence that diploma mill PhDs have any worse outcomes than their brick and mortar counterparts? Should diploma mills proliferate and even more so and get funding until reputable universities publish such data? If Pfizer developes a new medication, should they skip Phase I-III trials and get the product on the market until someone else comes along to prove the drug is or isn't safe and/or is or isn't effective?

Overall, I believe Rx psychology is bad for public health. Not because I believe psychologists will be inadvertently killing people left and right -- hell, a handful of high school kids have posed as physicians and treated patients in many settings, including ERs, over reasonably-lengthy periods or time without any evidence of adverse events. I find it highly unlikely that people will be dropping dead when some psychologist starts prescribing Zoloft. The biggest problem is this false narrative in society about the greater need for psychiatric medications and the continual overselling of ideas that perpetuate society's external locus of control. The biggest problem I deal with on a daily basis and the largest barrier to clinical improvement, bar none, is the externalization of problems and the reliance on external sources of validation for inward problems. The analogy of diabetes is rather appropriate. Type I and type II are very different fundamentally but ultimately have some similar outcomes because they both fall under the diabetes umbrella by virtue of elevating blood glucose levels. There are certainly things a type I diabetic can do to modify many of their risk factors but it is certainly a disease that can just happen upon someone. When society blurs the lines between the two, we make assumptions about diabetes as a whole and start to de-emphasize lifestyle modification in favor of a disease model. Only 10% of diabetics are type I. I'm kind of going off on a tangent here, but irrational societal beliefs help accentuate and perpetuate a very strong external locus of control. I see Rx psychology as similar to a personal trainer at the gym wanting the ability to prescribe insulin to type II diabetics. The personal trainer -- functioning as a personal trainer -- will have more power to help the individual as well as society by assisting that person with personal improvement through training and not inappropriately prescribing insulin. Every time some antisocial shoots up a public space, we hear cries for more mental health funding. Many people in mental health fields eat this up and use these tragedies to push this agenda, too, but we all know it's nonsense. We believe in mental health treatment, but not necessarily for preventing willful human behavior, but many are willing to hide behind that to push agenda. So too Rx psychology.

The other questions that must be asked is which populations are being targeted with this? To read the political narrative would reference that difficult access to psychiatrists -- which is really more a problem of treating the "under-served" or, more specifically, severely mentally ill populations -- are the targets. Are psychologists looking to go in to community mental health centers and treat people with schizophrenia, manage long-acting injectables or maintain someone on clozapine? Are they going to manage medications for a person with multiple hospitalizations for mania who had to be taken off lithium because of CKD and also has Parkinson's? Or are they looking to supplement psychotherapy with Prozac? Or offer different augmentation and polypharmacy that a PCP would not? We all know that Rx psychologists would, or most likely should, recognize the limits of their training and, with some small exceptions, I'm sure, would not be treating a lot of the SMI or medically complex. Even the DoD psychologists were prescribing antipsychotics <10% of the time. One of my questions is, of those in, say, rural Idaho, who have access to a psychologist, what percentage of those don't also have access to a PCP? If this is the population Rx psychology is looking for, I wish they'd just say that and argue those points in the political sphere. But, of course, as this is political, it's being sold on how important access to care is and using populations that the Rx psychologist won't be seeing as justification for advancing this agenda. Seems to play out like a bait and switch.

To accept the idea of Rx psychology you have to accept a few false premises:

1. There's a shortage of access to psychiatric medications.
2. This shortage of access to psychiatric medications is adversely affecting the population (they even reference suicides in this Idaho link in OP).
3. Expanding the scope of practice for non-psychiatrists to prescribe these medications will help alleviate this problem.
4. Current state regulations in Rx states is sufficient criteria for psychologists to effectively step in to this role.

If we're talking about lack of evidence, there's absolutely no evidence for any of those premises. I guess it's the AMA's job to prove those premises aren't true?

 

[st2205]

There is no "unless it is inconvenient" caveat for the scientific process.

This seems to cut both ways.

 

[PsyDr]

@st2205, so when osteopaths were okayed there was such evidence?

 

[WisNeuro]

I've mentioned before that if one argues for challenging the status quo, then the onus is on them to demonstrate reason for change rather than an appeal to a lack of evidence as reason for changing status quo, implying that without evidence anything goes. If we're going by the Department of Defense report, if we're calling the amalgam of interviews of people supervising and working in proximity to Rx psychologists with the lack of negative outcomes being evidence, then none of these programs resemble the Department of Defense's prescribing psychologist program.


If we're talking about lack of evidence, there's absolutely no evidence for any of those premises. I guess it's the AMA's job to prove those premises aren't true?

Except the status quo has never really produced evidence of their own safety and efficacy, therefore they are holding others to a different level of responsibility than they themselves hold. The outcome goalposts should be the same for everyone. I'm a firm believer, in all of healthcare, if you are worried about midlevels and other providers on your turf, you have to show people why you can do a better and/or safer job. "Because that's the way we've always done it" just doesn't cut it.

 

[Mad Jack]

There is no "unless it is inconvenient" caveat for the scientific process.

And yet people claim equivalence without requiring any scientific proof for such equivalence. Funny how that works.

 

[Mad Jack]

I imagine the AMA has plenty of money. Hardly a reason not to do a study if one feels it's warranted.

The AMA doesn't represent physician specialty interests, or do studies of any such significance. That isn't their purpose.

 

[WisNeuro]

The AMA doesn't represent physician specialty interests, or do studies of any such significance. That isn't their purpose.

"Our mission is to promote the art and science of medicine and the betterment of public health."

Seems to be in line with their mission . Maybe they should start. Other trade organizations do.

 

[Mad Jack]

"Our mission is to promote the art and science of medicine and the betterment of public health."

Seems to be in line with their mission . Maybe they should start. Other trade organizations do.

They aren't a trade organization. The AMA is a lobbying group that represents academic medicine and public health. To say that this is in their purview shows how much you don't understand the profession of medicine. Saying the AMA should represent psychiatrists against psychologists is like saying AAA should represent American automotive manufacturers against foreign competitors, it just doesn't make any sense because that isn't what the organization does it is about at all.

 

[st2205]

@st2205, so when osteopaths were okayed there was such evidence?

In the 60s? No. All other historical convergence aside, they brought their curriculum up to the level of their allopathic counter parts and required the same clinical training. What they didn't do was create a completely different training model with drastically lesser rigor and exposure and ask it be recognized as a reasonable path for medical licensure.

Except the status quo has never really produced evidence of their own safety and efficacy, therefore they are holding others to a different level of responsibility than they themselves hold. The outcome goalposts should be the same for everyone.

You're arguing for lowering the standard of the status quo and believe it's a more valid question to have the supporters of a higher standard justify that standard than it is for supporters of a lower standard to justify theirs. That's a very interesting proposition. How well does that work in other venues?

- There's no evidence that internship and practicuum experience for PhD and PsyD produces better outcomes. You could solve this bottle-neck problem by awarding doctoral degrees after completion of didactic curriculum and have that be the criteria for licensure, unless those advocating for the necessity of clinical practica can prove it's superior (data only, please, no opinions or appeals to common sense).

- There's no evidence that those who score less than 70% on EPPP have any worse outcomes than those scoring above 70%. Who shoulders the burden of proof to lower that to 60% (no opinions, just data)?

- There's no evidence outside of historical anecdote for the justification of FDA regulations on medications. A lot of their regulations are actually quite problematic. If the FDA doesn't put up this data justifying their methods with actual data, should we lower the standard to some other standard without any evidence, citing the lack of FDA evidence as justification?

- There's no evidence that neuropsychologists have any better outcomes than general psychologists in the recommendations produced from neuropsychological testing. I've had patients waiting ~6 months to get in for neuropsych testing and we could really shorten this. You have data "protecting your turf," I presume (data only, please)?

I'm a firm believer, in all of healthcare, if you are worried about midlevels and other providers on your turf, you have to show people why you can do a better and/or safer job. "Because that's the way we've always done it" just doesn't cut it.

You keep mentioning turf as a key point to your argument, which is interesting, and makes me wonder if on a deeper level you view this more fundamentally from the perspective of expanding turf than anything else.

 

[WisNeuro]

They aren't a trade organization. The AMA is a lobbying group that represents academic medicine and public health. To say that this is in their purview shows how much you don't understand the profession of medicine. Saying the AMA should represent psychiatrists against psychologists is like saying AAA should represent American automotive manufacturers against foreign competitors, it just doesn't make any sense because that isn't what the organization does it is about at all.

Potayto, potahto, still besides any relevant point.

 

[WisNeuro]

In the 60s? No. All other historical convergence aside, they brought their curriculum up to the level of their allopathic counter parts and required the same clinical training. What they didn't do was create a completely different training model with drastically lesser rigor and exposure and ask it be recognized as a reasonable path for medical licensure.


You're arguing for lowering the standard of the status quo and believe it's a more valid question to have the supporters of a higher standard justify that standard than it is for supporters of a lower standard to justify theirs. That's a very interesting proposition. How well does that work in other venues?

- There's no evidence that internship and practicuum experience for PhD and PsyD produces better outcomes. You could solve this bottle-neck problem by awarding doctoral degrees after completion of didactic curriculum and have that be the criteria for licensure, unless those advocating for the necessity of clinical practica can prove it's superior (data only, please, no opinions or appeals to common sense).

- There's no evidence that those who score less than 70% on EPPP have any worse outcomes than those scoring above 70%. Who shoulders the burden of proof to lower that to 60% (no opinions, just data)?

- There's no evidence outside of historical anecdote for the justification of FDA regulations on medications. A lot of their regulations are actually quite problematic. If the FDA doesn't put up this data justifying their methods with actual data, should we lower the standard to some other standard without any evidence, citing the lack of FDA evidence as justification?

- There's no evidence that neuropsychologists have any better outcomes than general psychologists in the recommendations produced from neuropsychological testing. I've had patients waiting ~6 months to get in for neuropsych testing and we could really shorten this. You have data "protecting your turf," I presume (data only, please)?



You keep mentioning turf as a key point to your argument, which is interesting, and makes me wonder if on a deeper level you view this more fundamentally from the perspective of expanding turf than anything else.

We have little mini-battles against mid levels all of the time in psychology. I believe that we also need to engage in outcome research to examine the efficacy. Which is why we have initiatives in several of our organizations for such related research. All of us in healthcare need this. I wholeheartedly agree, let's get more data. At the moment, all I can bring to mind if some retrospective data that npsych evals showed an association with decreased ED visits. Not the most compelling case. So yes, more data, please! Data for everyone!

 

[st2205]

We have little mini-battles against mid levels all of the time in psychology. I believe that we also need to engage in outcome research to examine the efficacy. Which is why we have initiatives in several of our organizations for such related research. All of us in healthcare need this. I wholeheartedly agree, let's get more data. At the moment, all I can bring to mind if some retrospective data that npsych evals showed an association with decreased ED visits. Not the most compelling case. So yes, more data, please! Data for everyone!

But in the meantime... policy free-for-all?

 

[WisNeuro]

But in the meantime... policy free-for-all?

I lean more libertarian on some things anyway. But, until then, I guess we just keep doing what we're doing, fighting turf wars based in opinions and anecdotes. At the very least, we should just be honest about it.

 

[smalltownpsych]

At a certain point, the data will show up to demonstrate that psychologists should prescribe psychotropic medications and all of the organizations and media will rally behind it. It will occur right after the pharmaceutical companies see that is profitable to support RxP as a means for expanding their market. Science? Medicine? Ethical practice? lol. We are small potatoes in the scheme of things.

 

[Mad Jack]

Potayto, potahto, still besides any relevant point.

If you'd like a relevant point, how about the idea that a drug has to to go through rigorous trials and testing before being unleashed on the public and psychologists just saying, "oh, we'll just do it and see how things turn out with prescribing." Maybe we should take the same approach with all of healthcare...

 

[st2205]

I lean more libertarian on some things anyway. But, until then, I guess we just keep doing what we're doing, fighting turf wars based in opinions and anecdotes. At the very least, we should just be honest about it.

Which is what I'm all for -- honesty. Both sides can look at the comparison between current Rx psychology programs and the current standard of care and find that they are hideously unequal, but we keep side-stepping this issue by averting gaze from it by saying "hey, let's not actually compare the curricula and clinical experience, let's just look at the [lack of] facts, man." Somehow we justify suspending all logic because "there just aren't any facts available to make a conclusion." We'd be equally dishonest to pretend bemusement as to whether general psychologists should interpret and make recommendations on neuropsychological testing because there's no data saying it's bad, or to say "there's just no damn way of knowing" if 60% on the EPPP is sufficiently inferior to 85% because of no published data comparing the two.

This paper from BMJ comes to mind...

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials

Abstract
OBJECTIVES:

To determine whether parachutes are effective in preventing major trauma related to gravitational challenge. Design Systematic review of randomised controlled trials.

DATA SOURCES:
Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.

STUDY SELECTION:
Studies showing the effects of using a parachute during free fall.

MAIN OUTCOME MEASURE:
Death or major trauma, defined as an injury severity score > 15.

RESULTS:
We were unable to identify any randomised controlled trials of parachute intervention.

CONCLUSIONS:
As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. - PubMed - NCBI

 

[WisNeuro]

Which is what I'm all for -- honesty. Both sides can look at the comparison between current Rx psychology programs and the current standard of care and find that they are hideously unequal, but we keep side-stepping this issue by averting gaze from it by saying "hey, let's not actually compare the curricula and clinical experience, let's just look at the [lack of] facts, man." Somehow we justify suspending all logic because "there just aren't any facts available to make a conclusion."

Unequal does not always equate to inadequate. And I'm not convinced that some of the training programs out there don't meet the adequacy benchmark. I'm willing to be convinced, but no one's done a good job at it yet.

 

[st2205]

Unequal does not always equate to inadequate. And I'm not convinced that some of the training programs out there don't meet the adequacy benchmark. I'm willing to be convinced, but no one's done a good job at it yet.

And this is the crux of the issue:

A) until outcome data on RxP is known, the standard of care status quo should be maintained.

B) until outcome data shows RxP is inferior, the standard of care status quo should be lowered.

This is even if it's granted that we strip the argument of 'people who have gone through the training can testify that a non-existent practicuum is not sufficient to adequately learn what's needed' from the debate and just focus on "the facts."

 

[WisNeuro]

Well it's a crux of an issue, not necessarily the issue, to me. Standard of care has rarely been operationalized in any empirical, systematic way. Across healthcare. Status quo for status quo's sake is no bueno in my book.

 

[st2205]

Well it's a crux of an issue, not necessarily the issue, to me. Standard of care has rarely been operationalized in any empirical, systematic way. Across healthcare. Status quo for status quo's sake is no bueno in my book.

And I'm all about challenging the status quo. RxP isn't challenging the status quo -- it's asking it to be ignored.

 

[WisNeuro]

And I'm all about challenging the status quo. RxP isn't challenging the status quo -- it's asking it to be ignored.

I guess we'll agree to disagree there.

 

[medicool]

Just out of curiosity, what percentage of psychologists work with manic or psychotic patients, or patients on multiple psychotropic medications (barring forensic). The average PCP does not seem to have an issue prescribing Prozac and the like and are sometimes even quicker in trying the newer antidepressants, but won't touch mood stabilizers or antipsychotics with a 10-foot pole. My limited experience has been that psychologists generally tend to see people with an ability to process things or at least ones they hope will get to that point. What percentage of psychologists take Medicare/Medicaid. The critical argument for the RxP has been access to care. Personally I believe bad outcomes can happen with anyone but the fact that you will likely see a good amount of geriatric population also means that pure psychopharmacology alone is not going to be sufficient. You are more likely to miss things that you do not know.

 

[st2205]

I guess we'll agree to disagree there.

I meant challenging with data. There's plenty I don't like about FDA regulations that aren't backed by evidence, but I understand that should that be challenged and restrictions eased up, it has to be from data and not just my angst that the FDA standard wasn't based on evidence. Hell, I hate how tightly regulated a lot of issues with clozapine are and have had some problems with being handcuffed from good patient care because of some policies that sprung up from conventional wisdom and guesses rather than actual research. I'd like to see that change. But, more importantly, change has to be accompanied by specific evidence and not just "hey, this isn't evidence-based so we're going to try something else a little less stringent that also isn't evidence based, okay?"

And if we're that concerned about data for status quo, should we establish whether more medications is a good thing, that there's evidence for that, that it will reduce suicide rates, as is being mentioned of why there's political expediency for this process to get passed everywhere?

 

[WisNeuro]

I meant challenging with data.

I get that, I'd love to see more definitive data as well, but we suck at that in the US healthcare system by and large. In a certain respect, the DoD data and the 10+ years of LA and NM prescribing is the same data that is present on the other side as to efficacy. I want to see data too, but I don't think it can be unilaterally applied to any "challenger" when the bar was never met by an incumbent source in the first place. Sure, let's set some bars, but let's all meet them.

 

[PsyDr]

In the 60s? No. All other historical convergence aside, they brought their curriculum up to the level of their allopathic counter parts and required the same clinical training. What they didn't do was create a completely different training model with drastically lesser rigor and exposure and ask it be recognized as a reasonable path for medical licensure.

You may wish to consult references for that. From 1937-1961 there was an absolute different training model. If one look s at 1937, one would see that 26 states accepted DOs into practice. In 1961, the California Medical board gave a wholly different training model by granting MDs to individuals practicing with a DO degree, which is a pretty different training model. Individuals with MBBS have different training by merit of undergrad.

 

[st2205]

You may wish to consult references for that. From 1937-1961 there was an absolute different training model. If one look s at 1937, one would see that 26 states accepted DOs into practice. In 1961, the California Medical board gave a wholly different training model by granting MDs to individuals practicing with a DO degree, which is a pretty different training model. Individuals with MBBS have different training by merit of undergrad.

Osteopathic medicine was certainly a different training model -- that's clearly how it originated. Allopathic medicine was different, too. We're talking about the late 1800s and early 1900s. It wasn't until the early 70s that they were eligible for licensure in all 50 states. They started improving upon curriculum and requirements after the Flexner report and, over time, advances in medicine slowly brought osteopathic medicine and "allopathic" medicine together. Osteopathic medicine continued to raise standards of training to mirror "allopathic" medical schools before they were recognized as medical physicians, not a radically different model.

Regarding MBBS, you're correct that training abroad is a bit different. Regardless, they still have to complete residency training in the US (the essential component of practicing as a physician).

 

[deleted343839]

The average PCP does not seem to have an issue prescribing Prozac and the like and are sometimes even quicker in trying the newer antidepressants, but won't touch mood stabilizers or antipsychotics with a 10-foot pole.

The new Idaho law states that prescribing psychologists must "collaborate" with the patient's "licensed medical provider," so I think it is legitimate to question how many psychologists will actually assume risks that a physician, NP, or PA won't.

What percentage of psychologists take Medicare/Medicaid.

Medicare, some. Medicaid, very few. The access issue has always been a tough sell.

 

[jadedphysiotherapist]

@Mad Jack

You would probably agree that the usury of the federal government on training models and the interest rates being mitigated or the ability to discharge into bankruptcy would significantly drive down turf wars right?

My opinion is that Rx should only be done following med residency training hours as you change biology following Rx.

At the same time, you use what....10 percent of the material used from med curricula and associated rotations? Psychologists have a linear training pathway but lack 24/7 monitoring of patients following hospitalization so it lacks that monitoring.

Legality protection interest would follow more libertarian models if the Fed and the academic administrators didn't serve such a broken role

 

[Mad Jack]

@Mad Jack

You would probably agree that the usury of the federal government on training models and the interest rates being mitigated or the ability to discharge into bankruptcy would significantly drive down turf wars right?

My opinion is that Rx should only be done following med residency training hours as you change biology following Rx.

At the same time, you use what....10 percent of the material used from med curricula and associated rotations? Psychologists have a linear training pathway but lack 24/7 monitoring of patients following hospitalization.

Legality protection interest would follow more libertarian models if the Fed and the academic administrators didn't serve such a broken role

It's really more like 30% of med, of which only about a third is psychiatry. Two thirds of what a good psychiatrist is has nothing to do with therapy or drugs, it's all about sorting what's organic, what is caused iatrigenically by non-psych meds, and what interactions are occurring between psych meds and non-psych meds, as well as managing the morbidity of psych meds.

I'd be fine with psychologists prescribing after a four year residency with a year of general medicine and neurology and a year of didactic anatomy, physiology, and pharmacology dedicated to non-psych medicine.

 

[jadedphysiotherapist]

It's really more like 30% of med, of which only about a third is psychiatry. Two thirds of what a good psychiatrist is has nothing to do with therapy or drugs, it's all about sorting what's organic, what is caused iatrigenically by non-psych meds, and what interactions are occurring between psych meds and non-psych meds, as well as managing the morbidity of psych meds.

I'd be fine with psychologists prescribing after a four year residency with a year of general medicine and neurology and a year of didactic anatomy, physiology, and pharmacology dedicated to non-psych medicine.

And this is good defense and rationale which rarely occurs. I argue that residency timelength should conform to federal lending trends and, primarily, cases rather than old calendar year timelengths that simply get longer and stay the same.

A training pathway linearly trained for a system shouldn't receive the same residency pathway as medical as you have linear training, but Rx as a service should have some conformity.....aka 1 year of a med psych/neuro in hospital residency training with a step 1 testing beforehand in didactic with that conforming. The pathway would still decrease from the current psychiatry timelength and debt to income would be manageable without a subsequent of overcharge to the public to pay bills and loans.

 

[Therapist4Chnge]

I'd be fine with psychologists prescribing after a four year residency with a year of general medicine and neurology and a year of didactic anatomy, physiology, and pharmacology dedicated to non-psych medicine.

Just like NPs and PAs?

 

[jadedphysiotherapist]

Just like NPs and PAs?

PAs under the authority and ethical business models of physicians in which their notes are being signed with supervision.

Business models get gamed but from a professional practice standpoint, PAS never attempt to be autonomous.

I'm sure @Mad Jack will agree.

NPS are a completely different thing in regards to their leadership and defining "nursing scope" which is an attempt to overtake PCP scope.

You should look at step 1 questions. Until other professions hit those pathophys 3 step questions, it becomes somewhat obvious as to why some structure and conformity should come to Rx privileges. There is a reason for why that test is given consistently as it assesses everything encountered in medicine.

 

[Mad Jack]

Just like NPs and PAs?

I don't think NPs and PAs should be independently prescribing, but at least they have basic pathophysiology training.

 

[chicandtoughness]

That people think they can prescribe them like it's no big deal after a brief course highlights just how little they know.

I'm curious: how long do you think a course needs to be in order to prescribe a narrow set of medications? Two years of psychopharmacology, while nowhere near comprehensive, seems typical for most of these post-doctoral M.S. programs. Do you think having psychologists do the equivalent of a psychopharm fellowship would be more effective?

Not oppositional, just trying to understand perspectives.