Oregon Senate Passes Bill to Let NPs supervise Psychologists in prescribing psych meds

[northernpsy]

In spite of the efforts by several psychiatrists to explain why psychologists should not be prescribing psych meds, it looks like soon psychologists WILL be allowed to prescribe psych meds over in Oregon. The cherry on top? NPs can be the ones supervising these psychologists. Because, you see, the NPs have convinced legislators that they have "the heart of a nurse and the brains of a doctor", so why do we need physicians at all? Now you see why I refuse to have anything to do with supervising or training NPs and have started trying to raise awareness of how far things have gone with these efforts to let poorly trained people take over the healthcare of vulnerable individuals.

Please considering getting involved with your state medical society to help in the fight against this kind of thing.
Here is what a lobbyist who was fighting this in OR had to say about the vote on this bill:

"Everyone,
HB 3355 passed 18-11 today.
Sen. Monnes Anderson made the point there's a 6-week waiting list to see a psychiatrist and characterized this as a bill to improve access. She said in other states it's not a public safety issue -- and that other providers will be "around" and it's a collaborative model.
Sen. Steiner Hayward said her decision to be a "no" was a hard decision. Doesn't disagree we need more prescribing providers. However, the more she looked into the training required, showed her that it was primarily online with only 40-hours of physical exams. She's says this isn't a turf issue, it's a patient safety issue. Hopes rule making process is inclusive but not optimistic this will result in increased numbers of providers in rural communities. Noted, after the 2-year residency program, the psychologists will prescribe independently.
Sen. Frederick said his biggest issue is capacity -- we're rated "lowest" in the country for mental health support. His families have to wait weeks or months for help. He called psychiatrists in other states, including LA said their problems have been addressed with this bill.
Sen. Gelser, agreed access is a challenge. However doesn't think this bill is the solution -- putting expediency over safety. Her personal pediatrician stopped her in the grocery store to say how concerned she was about the bill. She's received dozens of calls.
Sen. Olson was torn -- if we vote for this bill and we are wrong, patients will suffer.
Sen. Monroe closed by saying he has a sister with mental illness and noted her caregivers have made all the difference. Mental health is a problem all over, including rural areas. NPs are primary providers in rural areas. Psychologists will be supervised by docs and NPs. Will be watching how this works. This may need to be adjusted in the future.
Our only option now is to seek a veto. I will be in touch regarding next steps."

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[heysexylady]

In spite of the efforts by several psychiatrists to explain why psychologists should not be prescribing psych meds, it looks like soon psychologists in prescribing psych meds over in Oregon. The cherry on top? NPs can be the ones supervising these psychologists. Because, you see, the NPs have convinced legislators that they have "the heart of a nurse and the brains of a doctor", so why do we need physicians at all? Now you see why I refuse to have anything to do with supervising or training NPs and have started trying to raise awareness of how far things have gone with these efforts to let poorly trained people take over the healthcare of vulnerable individuals.

Please considering getting involved with your state medical society to help in the fight against this kind of thing.
Here is what a lobbyist who was fighting this in OR had to say about the vote on this bill:

It's the blind leading the blind. Does this mean that np will no longer be supervised by a psychiatrist.

 

[splik]

Oregon NPs are independent they aren't supervised and by law psych NPs have to be reimbursed the same by insurance companies as psychiatrists...

 

[PistolPete]

Curious to see if this will affect Washington/California. Ugh.

 

[Shikima]

Fox meet chicken.

 

[nexus73]

Oregon NPs are independent they aren't supervised and by law psych NPs have to be reimbursed the same by insurance companies as psychiatrists...

stupid law

 

[Nasrudin]

Welp. This is what happens when all hierarchy is conceptualized as based on power and oppression. We don't work harder. For longer. With better intellectual DNA at our disposal. We don't benefit from tradition and a culture of training.

No. We're just a bunch of fat old white men smoking cigars and drinking whiskey and keeping all the little people under our boot. And laughing while we count our gold doubloons. That and since it's just oppression. We're corrupt and incompetent.

Except... when you need us. And...when...things being the way they are... you can afford us. It's for this reason I'm not giving my own pursuit of excellence entirely over to The People. What have they done to value it. Cash markets nullify this. You think a successful, intelligent person who has earned the the money to have access to the private shrink market is going to buy into the notion that Dr. McnurseyNurse is cut from the same cloth as us? No. So. The People have earned their squalor. I'm unabashed in my contempt for their ideologies. Conversely, it takes one to know one. If I give everything I have to being the best at this. People who are doing the same will recognize it. And I gotta say. I'd rather work with them than someone who thinks it's their birthright to be on psychiatric disability.

And I have the intuition that the more the squalor or lefty ideology flourishes, the more a counter stream develops. I don't plan on avoiding lefty locales. I'm betting people with common sense, who are self-made, and smart, know the value of a well made product.

 

[wolfvgang22]

It'll be interesting to see what happens when the inevitable bad outcomes and subsequent law suits occur.

 

[bannie22]

Hahaha

 

[F0nzie]

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[Nasrudin]

View attachment 220930


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hahahaha.

I always wonder if people from Portland get the jokes on Portlandia.

 

[PikminOC]

The APA must be having a stroke from this. Hopefully it doesn't start spreading to other states.


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You think the apa represents us? After they grandfathered themselves in and gave us moc?

 

[Shikima]

The APA must be having a stroke from this. Hopefully it doesn't start spreading to other states.


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Need to read up on NBPAS and why states are passing legislation against MOC.

 

[calvnandhobbs68]

Again these bills seem to (incorrectly) assume that the problem is the inability to put meds in the hands of patients that come to the psychologists for therapy. Instead of putting more money towards homeless shelters or substance abuse treatment or child protective services to keep people from abusing their kids, we'll put more prescribing pads out there to get Xanax and SSRIs in the hands of as much of the population as we can.

Classic American healthcare system. We won't pay for needle exchange programs but we'll pay the 10K a year for hepatitis C treatment.

Hell, this is just more ammo for the anti-mental illness wing to argue that we're doing all we can to push pills on the general population and turn everyone into zombies.

 

[st2205]

Imagine the amount of pride swallowing that must occur for a prescribing psychologist with a gigantic chip on their shoulder to be supervised (whatever that means) by someone with two years of formal psychiatric education.

 

[Psychotic]

Any other states that have done this (NPs are autonomous, and in turn can supervise psychologists who prescribe), or have bills pending?

Maybe all new NPs will move to Oregon where they are guaranteed equivalent pay to psychiatrists (is that done in other states?). Who will be left holding the bag when this all falls apart? The legislature? Oh no, all blame will be laid at the feet of psychiatrists, you can be sure of that.

 

[PikminOC]

I would hope that despite that, they would still want to protect turf for psychiatrists from psychologists and NPs.


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Nope. Too busy collecting fees and giving out meaningless moc to fill their coffers.

 

[Nasrudin]

I actually don't think there will be too much of difference. People are resilient. A functioning liver and kidneys can absorb a lot of crudeness in psychopharm--we have our own idiots to prove this. The way I see it. Is the game is not to be played in the middle or lower end of the art of practice. We need to double down and take full advantage of our opportunities for refinement. Pursue even more training in psychotherapy. Make a point of becoming pointlessly trained. Archaic. Like craftsmanship itself in this day and age of cheaply manufactured bull****.

We won't win a race to the bottom. Nor by fighting it.

We don't need these political bodies. We should bust them up. And deregulate. Give our training programs more room to breath. Let them evolve into distinct cultures with personality.

You can't fight this stuff.

If I were the evil overlord type. With that sort of motivation. I'd push to make it even easier for low end bulls!t to flood the market: You're a mental health aide? ... here's how you can get your RN/NP/MS/phd doctory thing at night, online.

But. Alas. I'm pathetically impeded by conscience.

 

[Nasrudin]

in other words.. i mean **** man... I'm on my day off. Hunting down a psychotic patient who has seen fit to loan his only working phone to some dude....(who I have had some hilarious conversations... so ok... I like the work... in all of it's little surprises) But I just need him to go get a lab draw. To take his Clozapine.

This is can be properly delegated to people with less training. The NP in our clinic is the right piece of the puzzle for this work. And gets assigned quite a bit of it. Static, palliative, cases. I know there's something of artful practice that can be brought to every encounter. But sometimes not. And anyone can do that. Anyone. It's not complicated.

Something will get lost in the shuffle. But then again. Something is already getting lost in the shuffle. so... idk man.

 

[Crayola227]

hahahaha.

I always wonder if people from Portland get the jokes on Portlandia.

they get it better than people not from there

 

[Nasrudin]

they get it better than people not from there

If you say so. I laughed my ass off watching it. And I've been there once. I guess the reason why I ask is part of the joke seems to be the characters blatant lack of self-awareness.

 

[birchswing]

Portland also has a white supremacist faction. I haven't seen all of Portlandia, but from what I have seen that part wasn't represented. I lived in Oregon, and it's extremely heterogeneous, both within the state and the couple of large cities. If you head east into the dessert you'll find some of the craziest anarchist types.

 

[deleted343839]

It'll be interesting to see what happens when the inevitable bad outcomes and subsequent law suits occur.

I've wondered about this for a while, but the data are hard to come by. Is anything tracking outcomes of non-physician prescribing? I'd think the APA (your APA, not my APA) would be all over it.

 

[Jules A]

I've wondered about this for a while, but the data are hard to come by. Is anything tracking outcomes of non-physician prescribing? I'd think the APA (your APA, not my APA) would be all over it.

Unfortunately there are problems securing this type of data although savvy lawyers might want to take notice of the NP bandwagon because in addition to deficient education there are many practicing outside their boarded specialty.

As Nasrudin mentioned its fairly hard to actually kill someone and in my anecdotal experience tragically with both mental health and substance abuse in many cases when a patient does die no one seems to care. Except when its one of the spoiled little darlings who Daddy never said no to, has wasted a semester of their Ivy League tuition and is heroin dependent...now those get noticed. Its a sad state of affairs with both professional and societal failings at the root.

 

[nowaysanjose]

Wouldn't equal pay actually be detrimental to NPs as it eliminates the incentive to hire them?

 

[splik]

NPs don't get equal pay in oregon, they get equal insurance reimbursement. As oregon is an independent practice state, there is nothing stopping them up hanging up a shingle and making the same as a psychiatrist in private practice. The better insurances in oregon pay about $350 for an intake. The concern is that insurance companies will lower what they pay out for these codes now they have to pay the same for psych NPs and MDs.

 

[jadedphysiotherapist]

Wouldn't equal pay actually be detrimental to NPs as it eliminates the incentive to hire them?

No, because it still makes payors/admin more money from a higher cut. It would just drop the higher pay scale down.

 

[Shikima]

NPs don't get equal pay in oregon, they get equal insurance reimbursement. As oregon is an independent practice state, there is nothing stopping them up hanging up a shingle and making the same as a psychiatrist in private practice. The better insurances in oregon pay about $350 for an intake. The concern is that insurance companies will lower what they pay out for these codes now they have to pay the same for psych NPs and MDs.

Holy crap! I'd love to see $350 for an intake! I'm lucky with the 170s I see now.

 

[nowaysanjose]

NPs don't get equal pay in oregon, they get equal insurance reimbursement. As oregon is an independent practice state, there is nothing stopping them up hanging up a shingle and making the same as a psychiatrist in private practice. The better insurances in oregon pay about $350 for an intake. The concern is that insurance companies will lower what they pay out for these codes now they have to pay the same for psych NPs and MDs.

Does the law not specifically prohibit the lowering of code reimbursement for MDs? Would the only way forward be to increase and standardize NP education requirements through federal action?

 

[calvnandhobbs68]

NPs don't get equal pay in oregon, they get equal insurance reimbursement. As oregon is an independent practice state, there is nothing stopping them up hanging up a shingle and making the same as a psychiatrist in private practice. The better insurances in oregon pay about $350 for an intake. The concern is that insurance companies will lower what they pay out for these codes now they have to pay the same for psych NPs and MDs.

The problem becomes when NPs accept lower insurance reimbursement because of the lower cost of their schooling/willingness to accept less. Then insurance companies start asking why they can't pay the MDs less.

 

[Jules A]

Would the only way forward be to increase and standardize NP education requirements through federal action?

This would be ideal and seems the only rational move however I doubt it would ever happen. The universities and credentialing agencies are making serious bank with the current trend of seducing students early and keeping them fueling the tuition gravy train from undergrad through graduate school. Once again I feel compelled to add that most no longer have a requirement to practice as a RN. To the best of my knowledge CRNAs are the only specialty at this point not bastardizing their admission or graduation requirements, yet.

 

[deleted407021]

Shame, Oregon seemed like a nice place to live one day :/

 

[DrCommonSense]

In spite of the efforts by several psychiatrists to explain why psychologists should not be prescribing psych meds, it looks like soon psychologists WILL be allowed to prescribe psych meds over in Oregon. The cherry on top? NPs can be the ones supervising these psychologists. Because, you see, the NPs have convinced legislators that they have "the heart of a nurse and the brains of a doctor", so why do we need physicians at all? Now you see why I refuse to have anything to do with supervising or training NPs and have started trying to raise awareness of how far things have gone with these efforts to let poorly trained people take over the healthcare of vulnerable individuals.

Please considering getting involved with your state medical society to help in the fight against this kind of thing.
Here is what a lobbyist who was fighting this in OR had to say about the vote on this bill:

Welcome to the world of anesthesiology. Don't worry, Oregon hates physicians in general, so the more the merrier.

 

[DrCommonSense]

Curious to see if this will affect Washington/California. Ugh.

Depends on the status of the state. Most of the West Coast states hate physicians. I suspect Washington state will be next with that.

 

[DrCommonSense]

Welp. This is what happens when all hierarchy is conceptualized as based on power and oppression. We don't work harder. For longer. With better intellectual DNA at our disposal. We don't benefit from tradition and a culture of training.

No. We're just a bunch of fat old white men smoking cigars and drinking whiskey and keeping all the little people under our boot. And laughing while we count our gold doubloons. That and since it's just oppression. We're corrupt and incompetent.

Except... when you need us. And...when...things being the way they are... you can afford us. It's for this reason I'm not giving my own pursuit of excellence entirely over to The People. What have they done to value it. Cash markets nullify this. You think a successful, intelligent person who has earned the the money to have access to the private shrink market is going to buy into the notion that Dr. McnurseyNurse is cut from the same cloth as us? No. So. The People have earned their squalor. I'm unabashed in my contempt for their ideologies. Conversely, it takes one to know one. If I give everything I have to being the best at this. People who are doing the same will recognize it. And I gotta say. I'd rather work with them than someone who thinks it's their birthright to be on psychiatric disability.

And I have the intuition that the more the squalor or lefty ideology flourishes, the more a counter stream develops. I don't plan on avoiding lefty locales. I'm betting people with common sense, who are self-made, and smart, know the value of a well made product.

Alot of rich people on the West Coast pay for all kinds of weird stuff, so I wouldn't doubt they would substitute spirit healing for psych in terms of cash or summoning the spirits.

 

[DrCommonSense]

Portland also has a white supremacist faction. I haven't seen all of Portlandia, but from what I have seen that part wasn't represented. I lived in Oregon, and it's extremely heterogeneous, both within the state and the couple of large cities. If you head east into the dessert you'll find some of the craziest anarchist types.

Oregon does have some crazy White Nationalists but overall its mostly extreme left as shown by voting patterns.

 

[SeniorWrangler]

Alot of rich people on the West Coast pay for all kinds of weird stuff, so I wouldn't doubt they would substitute spirit healing for psych in terms of cash or summoning the spirits.

There are pain clinics in my home town that offer exactly this... you can get medications, procedures, or for a fee, the doctor will put on his shaman suit and wrestle with the bad spirits.
This does not offend me; in fact, it makes me feel envious. Once the psychologist-NP teams are handling all the psychopharmacology, maybe the psychiatrists can become the witch doctors we were always meant to be.

 

[jadedphysiotherapist]

Welcome to the world of anesthesiology. Don't worry, Oregon hates physicians in general, so the more the merrier.

Except that this was never originally a nursing practice as gas was.

It isn't procedural focused.

You need to see illness after illness from DSMV working heavy hours to differentiate symptoms and pathology.

 

[smalltownpsych]

Supervised by an NP? You have got to be kidding me. Everything that I have seen about their diagnostic and conceptual skills and prescription practices when it comes to mental health appears to be at or barely above the amateur level. If I see supportive psychotherapy on one more note from a nurse practitioner who has absolutely zero experience or training in providing psychotherapy, I swear I am going to blow. It would be like me documenting supportive medication management and advised patient on dosages and which combination of psychotropics to take based on...I don't know...Wikipedia? Maybe it is sample bias and there are some out there who really know what they are doing and the limitations of their training, but around here it sure seems as if they just like to wear the white coats and play doctor.

 

[smalltownpsych]

I also wanted to add that I don't hate midlevels in a lot of capacities and my own PCP is a PA. He does know quite a bit more about medicine than me so he has been helpful and he also is clear about limitations and when to refer and is very collaborative. My wife really likes him too. She didn't trust my treatment advice for her recently sprained ankle and came back from seeing him with almost the same advice some even word for word and she actually listened to him.

 

[Shikima]

Supervised by an NP? You have got to be kidding me. Everything that I have seen about their diagnostic and conceptual skills and prescription practices when it comes to mental health appears to be at or barely above the amateur level. If I see supportive psychotherapy on one more note from a nurse practitioner who has absolutely zero experience or training in providing psychotherapy, I swear I am going to blow. It would be like me documenting supportive medication management and advised patient on dosages and which combination of psychotropics to take based on...I don't know...Wikipedia? Maybe it is sample bias and there are some out there who really know what they are doing and the limitations of their training, but around here it sure seems as if they just like to wear the white coats and play doctor.

Interestingly enough, a psychologist (outside of the practice) working with a mutual trauma patient suggested that the patient go see a NP about medications over me because the NP has been in practice for 10 years.

 

[st2205]

Interestingly enough, a psychologist (outside of the practice) working with a mutual trauma patient suggested that the patient go see a NP about medications over me because the NP has been in practice for 10 years.

That's okay. A therapist suggested my patient see a psychic instead.

 

[NickNaylor]

Interestingly enough, a psychologist (outside of the practice) working with a mutual trauma patient suggested that the patient go see a NP about medications over me because the NP has been in practice for 10 years.

Don't forget his/her years of unassailable experience as an RN.

 

[smalltownpsych]

Interestingly enough, a psychologist (outside of the practice) working with a mutual trauma patient suggested that the patient go see a NP about medications over me because the NP has been in practice for 10 years.

Maybe the NP was more willing to prescribe the highly effective adderall plus xanax treatment.
Anybody want to take odds on that psychologist being from a questionable diploma mill program? As are most real psychologists, I'm pretty good at playing spot-the-quack psychologist just by reviewing CVs. It is always more difficult for those outside of a field to discriminate. Just like I wouldn't know a good med school or residency from a poor one.

 

[st2205]

Maybe the NP was more willing to prescribe the highly effective adderall plus xanax treatment.
Anybody want to take odds on that psychologist being from a questionable diploma mill program? As are most real psychologists, I'm pretty good at playing spot-the-quack psychologist just by reviewing CVs. It is always more difficult for those outside of a field to discriminate. Just like I wouldn't know a good med school or residency from a poor one.

The problem with psychiatry is that you can't discriminate very well on good versus bad psychiatrists based on medical school or residency.

 

[smalltownpsych]

The problem with psychiatry is that you can't discriminate very well on good versus bad psychiatrists based on medical school or residency.

I think we can only do it with the extremes and even then half of the psychologists that go to the weaker for-profit schools can actually be pretty competent. There are a lot more completely fake "psychologists" I think than there are fake psychiatrists though.

 

[Shikima]

Maybe the NP was more willing to prescribe the highly effective adderall plus xanax treatment.
Anybody want to take odds on that psychologist being from a questionable diploma mill program? As are most real psychologists, I'm pretty good at playing spot-the-quack psychologist just by reviewing CVs. It is always more difficult for those outside of a field to discriminate. Just like I wouldn't know a good med school or residency from a poor one.

Funny. Anxiety is terrible for her causing a significant psychosomatic response in the form of muscular contortion and mutism. I got her with a buttload of benzos and tapered her to Klonopin 1.5mg at bedtime with reasonably good results. Going back that way again was not in their treatment plan as it required higher and higher dosages for brief periods of time and then her returning back to the former state.

 

[JDoc9]

Every time I see a thread like this, I begin to worry about my job prospects as a psychiatrist. Are my concerns valid or should I chill?

 

[Nasrudin]

Every time I see a thread like this, I begin to worry about my job prospects as a psychiatrist. Are my concerns valid or should I chill?

Look. I mean. A job vs no job is not the issue. If anything, once we start competing for the same jobs at the same salaries, it's them that will have to worry about a job. I think the issue is more salary depression for salaried jobs. The other one being the pressure to supervise them. So that it could remove us from the clinical encounter in salaried jobs. I could foresee a clinical personnel manager type scope happening.

And then finally, the marxist deconstruction of our training system.

In either case. We can reach a zenith. A high water mark. That our way of doing things is threatened with extinction is more a question of our own resolve, ingenuity, and creativity as individual shrinks. Selection pressure requires deliberate action. There's an option of new niche creation with every new challenge.

 

[MysteryDiagnosis]

Why NP's? I'm not implying there bad because they're not, and yes they probably have more medical/ biological training than prescribing psychologist, but they have far less mental health/ psychiatric training.