Let this be a warning to all MD/DOs... California legislature/NPs just passed AB 890, which will likely grant FPA throughout the state.

[amestramgram]

The California legislature just moved one step further to making full practice authority the law of the land in California for nurse practitioners.

Bill Text - AB-890 Nurse practitioners: scope of practice: practice without standardized procedures.

While we all know great NPs, the state of medical education in NP schools these days is highly variable and is at times, frequently even, a mere shell of what medical school education represents.

A dentist/ politician basically screwed physicians over, and while public commentary was invited, physicians were constantly cut off, and no nurses were cut off - and physicians were again portrayed as people not to be trusted - who were greedy, fearmongering, and could only produce anecdotal evidence to support any harm in allowing NPs to practice independently.

So - I'm going to educate myself about the legal system as much as possible. I hope this inspires more on here to do the same.

What we really need is a Flexner report on the state of NP school education, and sadly, in the politicians and healthcare executives' eyes - enough people dying, before the general public realizes the danger this represents. Fight for all the Alexus Ochoas that died at the hands of incompetence.

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[GH253]

The worst is happening: the old vanguard of entrenched incumbents is losing its absolute monopoly on the practice of medicine. It will now only be a semi-monopoly, open to a whopping three groups instead of two.

 

[sylvanthus]

You realize this third group can do direct entry from an RN program, complete their program online with a mere 500 hours patient care experience, and practice independently now right? You really cool with that? Medicine is f’ed.

 

[PikminOC]

The worst is happening: the old vanguard of entrenched incumbents is losing its absolute monopoly on the practice of medicine. It will now only be a semi-monopoly, open to a whopping three groups instead of two.

You do know psychologists can prescribe in a few states also right?

 

[GH253]

Independent NPs should market themselves as unlicensed physicians that are cheaper and better than MDs.

 

[PikminOC]

Independent NPs should market themselves as unlicensed physicians that are cheaper and better than MDs.

They aren't cheaper

 

[Redpancreas]

You do know psychologists can prescribe in a few states also right?

Semi-necrobump, but

Psychologist: 4 year undergraduate degree, work/clinical experience usually after, 4-6 year PhD in Clinical Psychology, 1 year of supervised internship in Clinical Psychology, 1 year of supervised residency/fellowship, and 2 years of a Master's degree in Psychopharmacology followed by a National Board Exam). I think that's quite a lot of training. Maybe purists will say it's not medical school, but let's be real that there are focused elements of medicine (dopaminergic/serotonergic/NE pathways) required for Psychiatry. They don't need to know anatomy of the foot or about chemotherapy. Additionally, this is the equivalent of PGY-5 assuming candidates go straight through. Psychologists are doing this for 100K. I have a hard time imagining anyone gunning for a PGY-5 to do this.

 

[PikminOC]

Semi-necrobump, but

Psychologist: 4 year undergraduate degree, work/clinical experience usually after, 4-6 year PhD in Clinical Psychology, 1 year of supervised internship in Clinical Psychology, 1 year of supervised residency/fellowship, and 2 years of a Master's degree in Psychopharmacology followed by a National Board Exam). I think that's quite a lot of training. Maybe purists will say it's not medical school, but let's be real that there are focused elements of medicine (dopaminergic/serotonergic/NE pathways) required for Psychiatry. They don't need to know anatomy of the foot or about chemotherapy. Additionally, this is the equivalent of PGY-5 assuming candidates go straight through. Psychologists are doing this for 100K. I have a hard time imagining anyone gunning for a PGY-5 to do this.

They don't have to have a PhD. Can have MEd or psyd as well. Pgy 5 of what?
I use my medical knowledge every day with patients.

 

[Redpancreas]

They don't have to have a PhD. Can have MEd or psyd as well. Pgy 5 of what?
I use my medical knowledge every day with patients.

I don’t know about the MEd, but PsyD is basically a higher tuition/less academic equivalent of the PhD. PGY-5 of their 5 year PhD in Clinical Psychology at tier 1 research universities (not online) which is itself a 5 year program incorporating research and supervised clinical work. It’s awesome that you’re using your medical knowledge everyday as maybe knowing chemotherapy principles may make you more informed when seeing your patients with depression after a cancer dx. or what not. That said, the bread and better of medical complications that arise in psychiatry are extra-neural neurotransmitter physiology (dopaminergic pathways).

I noted this because I don’t think Psychologists deserved to be injected into this midlevel conversation. There is no one trying to go through training 2 years longer than the MD/DO -> Psychiatry route so they can get prescribing privileges for SSRIs. If they’re doing that after all the training they’ve done in psychology and pharmacology, I think they can prescribe psychoactive medication.

 

[PikminOC]

I don’t know about the MEd, but PsyD is basically a higher tuition/less academic equivalent of the PhD. PGY-5 of their 5 year PhD in Clinical Psychology at tier 1 research universities (not online) which is itself a 5 year program incorporating research and supervised clinical work. It’s awesome that you’re using your medical knowledge everyday as maybe knowing chemotherapy principles may make you more informed when seeing your patients with depression after a cancer dx. or what not. That said, the bread and better of medical complications that arise in psychiatry are extra-neural neurotransmitter physiology (dopaminergic pathways).

I noted this because I don’t think Psychologists deserved to be injected into this midlevel conversation. There is no one trying to go through training 2 years longer than the MD/DO -> Psychiatry route so they can get prescribing privileges for SSRIs. If they’re doing that after all the training they’ve done in psychology and pharmacology, I think they can prescribe psychoactive medication.

Thank you for your opinion

 

[Redpancreas]

Thank you for your opinion

That’s what our posts are.

 

[Splenda88]

I don’t know about the MEd, but PsyD is basically a higher tuition/less academic equivalent of the PhD. PGY-5 of their 5 year PhD in Clinical Psychology at tier 1 research universities (not online) which is itself a 5 year program incorporating research and supervised clinical work. It’s awesome that you’re using your medical knowledge everyday as maybe knowing chemotherapy principles may make you more informed when seeing your patients with depression after a cancer dx. or what not. That said, the bread and better of medical complications that arise in psychiatry are extra-neural neurotransmitter physiology (dopaminergic pathways).

I noted this because I don’t think Psychologists deserved to be injected into this midlevel conversation. There is no one trying to go through training 2 years longer than the MD/DO -> Psychiatry route so they can get prescribing privileges for SSRIs. If they’re doing that after all the training they’ve done in psychology and pharmacology, I think they can prescribe psychoactive medication.

Why go medical school then if it is not needed? Will they be able to recognize organic mental disorders? Let's say these PhD/Psy psychologists seeing someone with AIP (Acute Intermittent Porphyria) etc..., will they be able to recognize it and understand the pathophysiology?

If someone want to play doctor, go to med school. I was a RN and it would have been easier for me to keep working and do a 2-yr online NP , but I wanted play doctor, hence here I am now.

I like to think that almost everyone does their research before going to grad school so why suddenly everyone want to play a role they did not get trained for?

There is a reason psych is a branch of medicine because there so many organic disorders that have psychiatric manifestation

 

[Redpancreas]

Why go medical school then if it is not needed? Will they be able to recognize organic mental disorders? Let's say these PhD/Psy psychologists seeing someone with AIP (Acute Intermittent Porphyria) etc..., will they be able to recognize it and understand the pathophysiology?

If someone want to play doctor, go to med school. I was a RN and it would have been easier for me to keep working and do a 2-yr online NP , but I wanted play doctor, hence here I am now.

I like to think that almost everyone does their research before going to grad school so why suddenly everyone want to play a role they did not get trained for?

There is a reason psych is a branch of medicine because there so many organic disorders that have psychiatric manifestation

That's one of the few (not many) masqueraders. How many cases of AIP does one diagnose (not see on a medical history) as an IM PGY1/Psychiatry's medical residency's exposure? Most of these psychiatric manifestations are advanced forms of pathology of vasculitides/infections that ID/rheumatologists know as recognized neuropsychiatric complications with the treatment not including psychoactive medication, but treatment of the disorder. Exceptions include comorbid Axis I disorders precipitated by medical illness (cancer/MI), but I would argue an interdisciplinary approach (LSW, Psychologist, etc.) could be part of the team to manage those aspects. I think that Psychologists who already spend 5 years learning Psychology and how to recognize/diagnose mood disorders in addition to a year of internship, 1-2 years of residency, and two years of didactics in psychopharmacology followed by a board exam ought to be enough to able rx SSRIs. Prescribe Clozapine/Antipsychotics...maybe not even if they're trained in this with didactics unless they have clinical exposure and see the consequences with their own eyes, I don't think that's a good idea.

 

[Splenda88]

That's one of the few (not many) masqueraders. How many cases of AIP does one diagnose (not see on a medical history) as an IM PGY1/Psychiatry's medical residency's exposure? Most of these psychiatric manifestations are advanced forms of pathology of vasculitides/infections that ID/rheumatologists know as recognized neuropsychiatric complications with the treatment not including psychoactive medication, but treatment of the disorder. Exceptions include comorbid Axis I disorders precipitated by medical illness (cancer/MI), but I would argue an interdisciplinary approach (LSW, Psychologist, etc.) could be part of the team to manage those aspects. I think that Psychologists who already spend 5 years learning Psychology and how to recognize/diagnose mood disorders in addition to a year of internship, 1-2 years of residency, and two years of didactics in psychopharmacology followed by a board exam ought to be enough to able rx SSRIs. Prescribe Clozapine/Antipsychotics...maybe not even if they're trained in this with didactics unless they have clinical exposure and see the consequences with their own eyes, I don't think that's a good idea.

I don't know too well what Psy training entails, but I might advocate for these people to go back to do a shorter version of med school (2.5 yr med school and do a 3-yr psych residency). I have been a proponent in this forum to shorten the # of years it takes to become a doc (2 years prereqs +3 med school + 2-6 years residency)