Oregon wants prescribing rights for Psychologists

[Faebinder]

So they still claim they are happy with their scope?

Here is the link to Oregan State Legislature.

Here is the proposed House Bill 2702. They vote on this Monday afternoon. Feel free to voice your opinion to someone. I guess maybe in the future they want to do ECT, VNS, TMS and heck why not some spinal taps.

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Members don't see this ad.

 

[ronin12]

Frankly this is the price one has to pay being a psychiatrist,...working with psychologists!!!. I had some appreciation for them during residency, unfortunately after graduation the more I work with them more disappointed I get with their professional,moral and ethical standards.

 

[whopper]

Just as much justified in slamming the entire field of psychiatry based on the bad performance of one or even a few bad psychiatrists.

Oregon may have their reasons for doing what they are doing. There is a nationwide shortage of psychiatrists. The move to allow psychologists to prescribe may be one of desperation & a lesser of evils.

Its also one that the pharm companies in general have endorsed since it will up their distribution.

Most psychologists I've met don't want prescribing power.

If anyone here is against psychologists prescribing, and see it as a war, don't see it as if a borderline in a black & white splitting manner. Several psychologists agree they should not be able to prescribe, and if offered the oppurtunity would not take it. The pharm companies are also pushing & lobbying to prescribe, but your friendly neighborhood drug rep which is paid to kiss your butt, and give you a free dinner at a 5 star restaurant isn't letting you know this, so naturally the psychiatrists aren't getting mad at the pharm companies.

 

[Solideliquid]

"SECTION 12. { + This 2009 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2009 Act takes effect on
its passage. + } "


What? There aren't enough prescribing physicians (both psychiatrists and primary care) in Oregon?

And on the other hand very recently the Oregon Medical Board voted and passed a decision that does not allow international medical graduates (from medical schools not approved by the state of California) to attain a medical license. It made me think that perhaps there isn't a physician shortage in the state.

 

[ronin12]

It seems it is near impossible for foreign medical graduates to get medical license , despite residency training in USA.But psychologist might get back door opportunity to be medical providers.

Is it politics or share ignorance ?

 

[whopper]

I'd be interesting in knowing which if any of the pharm companies are lobbying the politicians to pass this bill.

And on the other hand very recently the Oregon Medical Board voted and passed a decision that does not allow internation medical graduates (from medical schools not approved by the state of California) to attain a medical license

In response to the Oregon-California Foreign Medical issue, the following site
http://www.mbc.ca.gov/applicant/schools_recognized.html#g
shows which medical schools they recognize.

Its a very long & comprehensive list, so don't equate that with not being able to attain a liscence if you're foreign medical graduate.

Every single FMG I've ever met whose medical school I can remember, their school is on that list, even ones from countries who aren't exactly getting along with the U.S.

It seems it is near impossible for foreign medical graduates to get medical license

Unless you went to medschool in North Korea, I wouldn't agree.

Graduate from a foreign medical school on the list (and heck its got schools from Iran, Somalia, what have you), pass USMLE 1,2 & 3, get ECFMG certified, get into a residency, and you should be able to get your liscence.

 

[ronin12]

I'd be interesting in knowing which if any of the pharm companies are lobbying the politicians to pass this bill.



In response to the Oregon-California Foreign Medical issue, the following site
http://www.mbc.ca.gov/applicant/schools_recognized.html#g
shows which medical schools they recognize.

Its a very long & comprehensive list, so don't equate that with not being able to attain a liscence if you're foreign medical graduate.

Every single FMG I've ever met whose medical school I can remember, their school is on that list, even ones from countries who aren't exactly getting along with the U.S.



Unless you went to medschool in North Korea, I wouldn't agree.

Graduate from a foreign medical school on the list (and heck its got schools from Iran, Somalia, what have you), pass USMLE 1,2 & 3, get ECFMG certified, get into a residency, and you should be able to get your liscence.

that's good to know. I guess I should get a chill pill , before responding to posts.

 

[whopper]

Well I guess I should mitigate some of my post.
If you're an FMG, you do have several things stacked against you. There is some prejudice against FMGs. Some places for example will never consider an FMG, no matter how good that FMG. A recent APA president was an FMG--Pedro Ruiz. I'd love to see some of the psychiatry residency programs that don't even look at an FMG application discuss their policy with him.

Anyway, I of course don't exactly like the idea of people getting onto our "turf", but other questions need to be asked, and psychologists as a whole should not be blamed as if we're in a locked in horn battle with them. We're not, & several psychologists back us up in our opinions on medication.

I've also noticed several psychologists knowing things far better than us (as a general trend, not in regards to judging an individual) psychiatrists in certain mental health aspects such as statistics, and unfortunately psychotherapy because psychiatrists are focusing more & more on the meds & medical model.

We as psychaitrists should look into & be very skeptical, perhaps even take action with non-physicians being able to prescribe medications. However don't start picking up the pitchforks & torches.

This is best handled by the state's APA (that's the psychiatric, not the pscyhological one). What is their opinion on this? If any residents here are in Oregon & are part of the APA, ask your local representative & the President of the resident's branch to look into it...

I'd demand it. I was a VP of the NJ APA resident's branch. Most residents I've seen who run for these positions dont' do anything in them anyway, and did it just for the CV (thankfully my President at the time, nor myself didn't, but the previous ones did). Throw some work on their laps. Make them earn their title that they ran for & were elected. Make them ask at the next state APA meeting what their state APA is going to do about it.

 

[Solideliquid]

In response to the Oregon-California Foreign Medical issue, the following site
http://www.mbc.ca.gov/applicant/schools_recognized.html#g
shows which medical schools they recognize.

Its a very long & comprehensive list, so don't equate that with not being able to attain a liscence if you're foreign medical graduate.

Perhaps I didn't make myself clear. Yes I'm aware that most foreign graduates can get a license. I was describing the current situation with Caribbean medical graduates (IMGs). The current as I understand it: the california medical board has approved most medical schools such as schools in the countries you listed. However for schools in the caribbean to be approved in CA the school must apply to the board and a lengthy process then either results in an approval or disapproval. Graduates from disapproved schools may not practice in CA. The trick is that other states such as Oregon are simply adopting the CA board decision without evaluating the schools for themselves.

 

[whopper]

The trick is that other states such as Oregon are simply adopting the CA board decision without evaluating the schools for themselves.

Interesting though not surprising. I guess they'll let the big brother handle the issue, and they'll just follow suit.

the school must apply to the board and a lengthy process then either results in an approval or disapproval

I don't know the process, and don't know how merit based it is. Several of the major ones in the Carribean such as SGU & Ross are there. I will state that while some Carribean medical schools such as SGU have developed decent reputations, you really have to watch out for some of them. Some of them were made with the only intention to be for profit and they were willing to do things such as hire someone still working on a master's degree to teach a course as if a professor (I know because I was offered one). Some of them have horrendous board pass rates.

So I do understand California demanding a review process. I actually think it is a great idea if it was merit based & fair because as a foreign grad myself (I went to SGU), I saw a number of things that I felt were being done right or were being improved upon only because the institution was being reviewed by third party sources in the US.

However I do not know if it is merit based or not. If it weren't it'd be a shame.

 

[ronin12]

Interesting though not surprising. I guess they'll let the big brother handle the issue, and they'll just follow suit.



I don't know the process, and don't know how merit based it is. Several of the major ones in the Carribean such as SGU & Ross are there. I will state that while some Carribean medical schools such as SGU have developed decent reputations, you really have to watch out for some of them. Some of them were made with the only intention to be for profit and they were willing to do things such as hire someone still working on a master's degree to teach a course as if a professor (I know because I was offered one). Some of them have horrendous board pass rates.

So I do understand California demanding a review process. I actually think it is a great idea if it was merit based & fair because as a foreign grad myself (I went to SGU), I saw a number of things that I felt were being done right or were being improved upon only because the institution was being reviewed by third party sources in the US.

However I do not know if it is merit based or not. If it weren't it'd be a shame.

I agree. no compromise on quality of medical education. we are dealing with human beings.

 

[sunlioness]

Anyway, I of course don't exactly like the idea of people getting onto our "turf", but other questions need to be asked, and psychologists as a whole should not be blamed as if we're in a locked in horn battle with them. We're not, & several psychologists back us up in our opinions on medication.

And just as you can't label all psychologists as "them", I wouldn't be quick to label all psychiatrists as "us" either. Not every psychiatrist opposes RxP for psychologists.

 

[toby jones]

I'm pissed at pharma.

 

[toby jones]

I'm pissed at pharma.

I'm not sure whether a lack of background in general medicine / non psychiatric medications will result in better or worse or much the same prescribing practices.

I kinda want to say that that is an empirical matter. But I'm sure pharma has got the studies well constructed already to either show 'things are better for us all in general' or they will fail to show that 'things are better for us all in general' which isn't of course the same as 'things have gotten worse'.

I have concerns about the overprescription of medications already. I don't expect this to help with that. Tap tap tap... Its a lot like when psychologists started running trials on psychoanalysis vs cbt...

 

[slight365]

Interesting how the students here equate FMG's only as Carribean or third world or even as somewhat "backwards" countries.

You guys do know that some of the world's top 50 and top 250 are also European schools? Hell, there are several ranked above Brown and Emory, for instance.

 

[BobA]

I think it's nuts that PA's need a supervising physician but psychologists don't.

 

[slight365]

That's crazy. Do NP's need a SP also in this case?

How much training to Psychologists get in pharmacology and clinical usage of drugs? And I don't mean incidental or CE credits.

 

[whopper]

In the oregon law, if you read it, it does require that psychologists go through a specific training program including pharmacology & psychopharm & such.

Actually if you ask me, that type of training can make more sense than the typical M.D. program, if the psychiatrist were only doing something as light as outpatient for non severe mental illness (not commitable, person is still able to function in society by themselves). I've often questioned the use of memorizing 10,000 histo slides in psychiatry.

However even with such training, such a psychologist would not be ready for hospital consultation, nor dealing with psychiatric patients whose medical problems are heavily interacting with a medical problem such as Conversion DO, Pseudoseizures, Clozaril use, required polypharmacy, Hep C patients requiring medication etc.

And I will add, unfortunately so too are not a lot of psychiatrists ready for such. Several psychiatrists as well as many other doctors in all fields tend to get lazy after residency, and forget their stuff. I've seen several psychiatrists where I look at their choice and meds and think to myself "WTF!". Half the time I get a patient transferred from another unit to my own, I check out their labs, see a cholesterol of 260, and the psychiatrist did nothing about it. They didn't even bother to ask the IM doc to check it out.

One thing that I've felt made clinical psychology superior to psychiatry training is being able to adopt a model looser than the medical model, and having more training in psychotherapy. IF you got 10 psychiatrists and ask them who Marsha Linehan is, I'd bet at least 5 of them would not know how to do it. I've yet to meet any psychiatrist who has yet done DBT for real, and knows how to do it, and their knowledge is more than superficial -its the treatment for Borderline PD- to satisfy the board exam.

So having more psychologists work with us, that's something I want. I worked in a health system in residency that didn't have someone with whom could refer Borderline patients. Everytime they got a Borderline, the staff & attendings kept whining "oh another Borderline", and no one was giving these people DBT or making a referral for such.

Having worked with a psychologist on my treatment team, its very good to have one (at least the ones I've had). Its great to ask them to do an MMPI, MFAST, SIRS, etc and be able to discuss the results. Its nice to have a psychologist on the staff that actually knows how to do DBT for real and does it, and you start seeing benefits from the DBT on your borderline patient, or a psychologist starting a behavioral treatment plan--having specific behaviors you want to see from the patient, and having that psychologist track the behaviors on a daily basis.

Overall, I'm against the idea of psychologists being able to prescribe, except maybe in a situation where the law specifically stated--no polypharmacy, only for non severe mental illness, only for mental health reasons, and only on meds with an extremely large safety margin (no lithium, no Depakote), and add to that--no hospital consultation, no inpatient, no meds that require labwork (heck that's almost all of them!), unless that psychologist were working hand in hand with a medical doctor who was overseeing the labs. I doubt many medical doctors would want to do that with a psychologist unless that doctor were in a family practice/PCP clinic that could not get their hands on a psychiatrist.

 

[ronin12]

In the oregon law, if you read it, it does require that psychologists go through a specific training program including pharmacology & psychopharm & such.

Actually if you ask me, that type of training can make more sense than the typical M.D. program, if the psychiatrist were only doing something as light as outpatient for non severe mental illness (not commitable, person is still able to function in society by themselves). I've often questioned the use of memorizing 10,000 histo slides in psychiatry.

However even with such training, such a psychologist would not be ready for hospital consultation, nor dealing with psychiatric patients whose medical problems are heavily interacting with a medical problem such as Conversion DO, Pseudoseizures, Clozaril use, required polypharmacy, Hep C patients requiring medication etc.

And I will add, unfortunately so too are not a lot of psychiatrists ready for such. Several psychiatrists as well as many other doctors in all fields tend to get lazy after residency, and forget their stuff. I've seen several psychiatrists where I look at their choice and meds and think to myself "WTF!". Half the time I get a patient transferred from another unit to my own, I check out their labs, see a cholesterol of 260, and the psychiatrist did nothing about it. They didn't even bother to ask the IM doc to check it out.

One thing that I've felt made clinical psychology superior to psychiatry training is being able to adopt a model looser than the medical model, and having more training in psychotherapy. IF you got 10 psychiatrists and ask them who Marsha Linehan is, I'd bet at least 5 of them would not know how to do it. I've yet to meet any psychiatrist who has yet done DBT for real, and knows how to do it, and their knowledge is more than superficial -its the treatment for Borderline PD- to satisfy the board exam.

So having more psychologists work with us, that's something I want. I worked in a health system in residency that didn't have someone with whom could refer Borderline patients. Everytime they got a Borderline, the staff & attendings kept whining "oh another Borderline", and no one was giving these people DBT or making a referral for such.

Having worked with a psychologist on my treatment team, its very good to have one (at least the ones I've had). Its great to ask them to do an MMPI, MFAST, SIRS, etc and be able to discuss the results. Its nice to have a psychologist on the staff that actually knows how to do DBT for real and does it, and you start seeing benefits from the DBT on your borderline patient, or a psychologist starting a behavioral treatment plan--having specific behaviors you want to see from the patient, and having that psychologist track the behaviors on a daily basis.

Overall, I'm against the idea of psychologists being able to prescribe, except maybe in a situation where the law specifically stated--no polypharmacy, only for non severe mental illness, only for mental health reasons, and only on meds with an extremely large safety margin (no lithium, no Depakote), and add to that--no hospital consultation, no inpatient, no meds that require labwork (heck that's almost all of them!), unless that psychologist were working hand in hand with a medical doctor who was overseeing the labs. I doubt many medical doctors would want to do that with a psychologist unless that doctor were in a family practice/PCP clinic that could not get their hands on a psychiatrist.

frankly not to undermine any profession's importance in mental health. DBT has very modest rate of improvement in overall outcome of BPD. regarding neuropsych/personality inventories having prepared for board oral /written gives reasonable amount of understanding. these are standarized tests and you intrepret the results, there is no rocket science involved. during my residency I was involved in research projects requiring neuropsych testings periodically to track improvement/no improvement. we had our research assistant(who non mental health person) administer the tests and we md's were interpreting them without much difficulty.

learning fundamentals of CBT, psychodynamic ,family and group therapy during residency would provide good understanding for pt's psychodynamics and help make appropriate refferals.

 

[PsyDGrrrl]

frankly not to undermine any profession's importance in mental health. DBT has very modest rate of improvement in overall outcome of BPD. regarding neuropsych/personality inventories having prepared for board oral /written gives reasonable amount of understanding. these are standarized tests and you intrepret the results, there is no rocket science involved. during my residency I was involved in research projects requiring neuropsych testings periodically to track improvement/no improvement. we had our research assistant(who non mental health person) administer the tests and we md's were interpreting them without much difficulty.

Actually, DBT has a very good success rate in treating borderline PD.

As for testing - while these may be administered with a standardized protocol, you do need training and expertise in interpreting them. Particularly neuropsych - there is no way a psychiatrist is qualified to do neuropsych testing, as even most psychologists aren't. It takes years and years of specialized training and supervised experience.

 

[Bluemirage]

I have been following this topic of psychologist prescription rights for sometime now. It is quite concerning to me that one state after another are allowing psychologists to prescribe after a crash course in pharmacology. I have alot of respect for psychologists and the role they fulfill in mental health care but I feel they are over stepping their training boundaries with their push for RX rights. I'm curious to know how the current attendings and residents feel about the following (assuming that eventually all states allow psychologists to RX):

-the professional security of psychiatry as a specialty?
-the future professional and practice dynamics between psychologists and psychiatrists?
-the safety of patients (it seems like there have been no reports of adverse outcomes in states like NM because of lack of voluntary reporting of AE's)?
-salary of psychiatrists?

PS- For anyone interested, here is a powerpoint file I had found of a PhD Psychologist lecturing on why Psychologists should not be allowed to prescribe:

 

[medium rare]

I wouldn't get too worried about the advancement of psychologist prescribing. As a clinical psychologist and psych NP, I have been prescribing for awhile now. I still refer to psychiatry on a regular basis, and the psychiatrists I work with appreciate the complex cases I send them. They are as busy as ever, and I don't think that psychologist prescribing will become so widespread that the need for psychiatrists will diminish considerably. You all, as psychiatrists, bring expertise to the clinical table that will not be replaced by prescribing psychologists or psych NPs.

As far as the training, the programs do vary, but those whose curriculums I have seen are quite thorough in terms of the course content and formal instruction. Clearly, they are more tailored to becoming a solid psychopharmacologist than the training I received in my psych NP program, and I went to a highly reputable and respected PMHNP program.

Psychologists have now been prescribing in New Mexico and Louisiana since 2004 without the impending apocalypse predicted by organized psychiatry. On the contrary, at the hospital in Las Cruces where I did my RN training, once hostile psychiatrists have become more accepting of the prescribing psychologists in town and the prescribing program for psychologists is supported by the hospital. In fact, the program is housed in the Family Medicine Residency Training Program - the only medical residency program in Las Cruces.

As psychologists, those prescribing in NM and LA have been collecting robust data on their prescribing practices and outcomes. They are now presenting their results in places like Oregon to promote Rx for psychologists. So, in my opinion, psychologist prescribing by state will become more widespread.

However, I don't think this is doom and gloom for psychiatry. I would like to see psychiatry take a more active role in training psychologists to prescribe as opposed to fighting them so intensely just to end up having to tolerate their prescribing in the future anyway. My thoughts are that the actual percentage of licensed psychologists who will ultimately pursue this postdoctoral training will be small. Remember, these training programs are postdoctoral and require you to be a licensed psychologist in order to complete the training; you can't get the training in graduate school.

Just my 2.

 

[diosa428]

As for testing - while these may be administered with a standardized protocol, you do need training and expertise in interpreting them. Particularly neuropsych - there is no way a psychiatrist is qualified to do neuropsych testing, as even most psychologists aren't. It takes years and years of specialized training and supervised experience.

As for medicating psychiatric patients - while medications may be administered with a standardized protocol, you do need training and expertise to do so appropriately. There is no way a psychologist is qualified to prescribe psychiatric medications, as even most physicians aren't comfortable doing so. It takes 4 years of medical school and years and years of specialized training and supervised experience (aka, residency).

Oh, aren't the parallels amazing?

 

[ronin12]

I wouldn't get too worried about the advancement of psychologist prescribing. As a clinical psychologist and psych NP, I have been prescribing for awhile now. I still refer to psychiatry on a regular basis, and the psychiatrists I work with appreciate the complex cases I send them. They are as busy as ever, and I don't think that psychologist prescribing will become so widespread that the need for psychiatrists will diminish considerably. You all, as psychiatrists, bring expertise to the clinical table that will not be replaced by prescribing psychologists or psych NPs.

As far as the training, the programs do vary, but those whose curriculums I have seen are quite thorough in terms of the course content and formal instruction. Clearly, they are more tailored to becoming a solid psychopharmacologist than the training I received in my psych NP program, and I went to a highly reputable and respected PMHNP program.

Psychologists have now been prescribing in New Mexico and Louisiana since 2004 without the impending apocalypse predicted by organized psychiatry. On the contrary, at the hospital in Las Cruces where I did my RN training, once hostile psychiatrists have become more accepting of the prescribing psychologists in town and the prescribing program for psychologists is supported by the hospital. In fact, the program is housed in the Family Medicine Residency Training Program - the only medical residency program in Las Cruces.

As psychologists, those prescribing in NM and LA have been collecting robust data on their prescribing practices and outcomes. They are now presenting their results in places like Oregon to promote Rx for psychologists. So, in my opinion, psychologist prescribing by state will become more widespread.

However, I don't think this is doom and gloom for psychiatry. I would like to see psychiatry take a more active role in training psychologists to prescribe as opposed to fighting them so intensely just to end up having to tolerate their prescribing in the future anyway. My thoughts are that the actual percentage of licensed psychologists who will ultimately pursue this postdoctoral training will be small. Remember, these training programs are postdoctoral and require you to be a licensed psychologist in order to complete the training; you can't get the training in graduate school.

Just my 2.

please accept my utmost respect for you being a psychologist and NP, but i have to be honest what my experience has been so far with NP's in psychiatry. most of the time the psych meds will do fine without major issues and it does not matter if they are prescribed by a np,psychologist, psychiatrist, prim care or "joe six pack". things start getting messy once medical issues, drug related mood, psychotic symptoms or frankly polypharmacy compications arise.
I have my several np colleagues who struggle with these fairly serious issues and unfortunately ultimately pt's suffer .they don't "DIE" because of apocalypse but sure do they suffer and they suffer big time. Mental health pt's are very vulnerable population and these side effects/lack of recognition of polypharmacy effects/medical issues keep on dragging for sometime until they are finally referred to psychiatrists to be sorted out. Again most of them live"THEY Don't DIE" but put yourself in their spot how many of you would like to experimented upon just because their provider lacks the essential knowledge and skills to understand and prevent these unfortunate incidences.

that's what I saw during residency and still observe it in my practice, again I apologize being blunt.

 

[PsyDGrrrl]

As for medicating psychiatric patients - while medications may be administered with a standardized protocol, you do need training and expertise to do so appropriately. There is no way a psychologist is qualified to prescribe psychiatric medications, as even most physicians aren't comfortable doing so. It takes 4 years of medical school and years and years of specialized training and supervised experience (aka, residency).

Oh, aren't the parallels amazing?

I never said I was in support of psychologists getting RX privileges.

 

[whopper]

i have to be honest what my experience has been so far with NP's in psychiatry

Fair enough, and I've seen a fair share of NPs not show elegant knowledge of psychopharmacology.

But then again I've seen my fair share of psychiatrists who don't have elegant knowledge either, yet these people were able to graduate from residency & practice. If I had a nickel for every psychiatrist I've seen who tended to give the same medication out to everybody....("Why do I choose Paxil? I always give out Paxil or Zyprexa, that's why" )

I don't know the above NP personally, & don't know the skills of the person above. However this person is also a psychologist, several of which I've seen have very good clinical skills and bring to the clinical table several aspects we psychiatrists often aren't trained in.

Just as much as I've argued in the past to anti-psychiatry posters to not judge the entire field as bad based on the actions of a few bad apples, don't do the same with the above poster either.

 

[Therapist4Chnge]

I am supportive of psychologist prescribing, though with some very specific guidelines that are not in place as of yet. I think even the best training out there needs more meat in the training (particularly in A&P and definitely more clinical hours), there should be required supervision by a physician, and there should be a limited formulary.....and this is by someone who's is going through the training now. I think the right program can produce better trained professionals than a traditional mid-level because of our added training in pathology and heavier focus on pharmacology....though that doesn't mean we should be independent. I think collaboration is the way to go with most psych cases anyway, but that may just be my bias.

I think places like Oregon, Missouri, etc are going to get prescribing rights, but my hope is they set a higher standard than what I've seen proposed. The data coming out of NM and LA has been promising, but I think those should be the bare minimum of requirements going forward. I see prescribing to be like neuro, where there may be an initial surge, the overall #'s should still be very low.

 

[OldPsychDoc]

At the risk of getting dragged into this yet again, I just want to state that I do not see this as being different from having numerous mid-levels and non-psychiatrically trained physicians prescribing psychotropics. We are NOT going to go out of business over this. It IS essential that we are involved and providing oversight (as we do for psychiatric mid-levels.)

 

[notdeadyet]

I just want to state that I do not see this as being different from having numerous mid-levels and non-psychiatrically trained physicians prescribing psychotropics.

When mid-levels were first brought in to deliver care customarily delivered by physicians (I'm thinking PAs and NPs, mostly), was there as much resistance from physicians as there has been for things like the issue of psychologists pushing for prescription rights?

I'm just curious if this situation is at all new or unique, or if doctors typically push back when non-physicians try to get rights usually reserved for doctors.

 

[chameleonknight]

As someone from Louisiana, experienced in the delivery of mental health care here, I can say that I'm not the slightest bit worried about having our income or territory reduced by a handful of PhDs writing scripts. As stated above, the majority do NOT want to handle med changes.

An important fact to remember is that while NPs, CRNAs, PAs, and other midlevels come from a much stronger biologic background, i.e. they wanted to be healthcare providers. Many psychologists see themselves are pscyhologists/counselors/academics and not mainstream providers of medicine. You can definitely forget them handling (or even wanting to handle) any case with polypharmacy or medical comorbidity.

I think we should get worried when we see a shift in training programs; when schools start advertising "Can't get into med school? Come do our prescriptive track psychology grad program for 4 years instead!"

 

[Therapist4Chnge]

I think we should get worried when we see a shift in training programs; when schools start advertising "Can't get into med school? Come do our prescriptive track psychology grad program for 4 years instead!"

NP/PA programs?

Most NPs/PAs I know chose their path based on the positives of the training and/or lifestyle and not because they couldn't go the MD/DO path, though some programs *do* push as an alternative to medical school.

As for clinical programs, they average 5-7 years just for clinical training, and then another 2 years for RxP training.

 

[notdeadyet]

As for clinical programs, they average 5-7 years just for clinical training, and then another 2 years for RxP training.

I've also heard the competition for the clinical programs is no joke either...

 

[BobA]

I've also heard the competition for the clinical programs is no joke either...

Are they getting paid during this time or accumulating debt like physicians?

 

[notdeadyet]

Are they getting paid during this time or accumulating debt like physicians?

No clue. I was talking about the 5-7 clinical years. I have no idea about the RxP time, if that's what you mean.

 

[Therapist4Chnge]

No clue. I was talking about the 5-7 clinical years. I have no idea about the RxP time, if that's what you mean.

Many programs pay their way during the clinical training (depends on their research funding). As for RxP time, I'd assume they are licensed psychologists, so they'd also be getting paid while completing the classes....though the clinical hours would depend on how they are structured. From what I've seen in LA, people do the hours in addition to their regular hours, so it takes a bit longer, but there is less loss of income.

 

[whopper]

I've only briefly perused the education requirements for psychologists to prescribe medications, so someone correct me if I'm off.

IMHO, you need a residency to be able to prescribe on the order of a physician. While I do have a tremendous respect for psychologists, psychiatric medications require a medical foundation. Will a psychologist be able to treat serotinergic syndrome? How about NMS?

IMHO, psychologists prescribing medications need some type of medical oversight more than academic. They would need a residency like training program. If they didn't have that, they'd have to have physician oversight to prescribe.

 

[kugel]

What do you suppose would happen if we psychiatrists treated this as an opportunity to help train others to do some of the "scut work" in psychiatry?
We would welcome the assistance, we would graciously offer to help develop the training, we would help teach the courses and we would offer to supervise some of them.


What if I had a mid-level seeing patients for follow-up for 2/3 of their appts?
What if I had a mid-level to contact family/friends for collateral info?
What if I had a mid-level to do psychotherapy better than I do (not a high bar, that one)?

Could all this be a "good" thing?
naaahhhh, I"m sure it is absolutely destined to be a disaster for all patients everywhere.

 

[Thorazine]

What if I had a mid-level to contact family/friends for collateral info?

isnt this what medical students are for? to make awkward phone calls to family while trying to explain their role on the team?
im just happy the next time i make this phone call, i can finally say im dr. thorazine!


i agree with some sort of physician oversight on this, as well as a limited formulary. i dont think psychologists should be prescribing lithium or clozaril. i think it would save everyone alot of time if physicians were involved in the training programs, instead of supervising psychologists on individual cases.

on my last inpatient psych rotation of med school, the unit chief had a weekly meeting with the NP to go over cases. is this the norm? i couldnt tell if he was doing this because he had to or because he wanted to. but never the less, it worked out for all involved.

 

[Therapist4Chnge]

i think it would save everyone alot of time if physicians were involved in the training programs, instead of supervising psychologists on individual cases.

They are, at least in my program (NSU) and the New Mexico St. program....I can't speak for other programs. My classes were taught by a mix of research pharmacists, physicians, and Neuro/A&P profs that teach both in the med school and clinical program. Practicum rotations are supervised by a physician/physicians.

As for the above stuff about "scut work"....you can keep your phone calls for gathering info , but the general idea of an active collaboration is something that I think would work well on both ends.

 

[whopper]

Could all this be a "good" thing?
naaahhhh, I"m sure it is absolutely destined to be a disaster for all patients everywhere.

I agree.

If you wanted to streamline treatment & cut costs, the psychiatrist for example could do more of the medication/medical monitoring & leave things such as H&Ps to others.

Several places have NPs doing grunt-work, and the psychiatrist simply peruses what's going on & gives his/her stamp of approval.

In a situation like that I would be more accepting of a psychologist prescribing-so long as a psychiatrist or other M.D. is overseeing what's going on.

There would also be benefits to the patient.

Several places do not offer psychotherapy, and the person has to go to a separate place for psychotherapy, disrupting the continuity of care. Several patients cannot get psychotherapy, or they can get it but cannot get a psychiatrist or other M.D. to prescribe psychiatric meds.

An all under 1 roof approach could be a good one, and this could help that.

If I had a practice, I'd definitely want a psychologist or Counselor to work with me. My wife is currently working on a Masters in Counseling and the depth of psychotherapy she is being taught is on a level far more than and residency I've ever seen. I can't possibly think any residency could train their residents on the order she's getting--over 40 hours a week in lectures & clinical training just in psychotherapy, and she has plenty of clients who are in need of medications who are experiencing hurdles getting them.

I'd feel very comfortable if a psychologist who had psychopharm training suggested a medication, and I had to be the one who reviewed the case & gave it my stamp of approval-Provided that I got to see the patient at least once in awhile for med monitoring and checking their labs, and a legal understanding that I should not be held responsible if the psychologist neglected to tell me something I needed to know that may have lead to a bad outcome.

 

[Solideliquid]

I've only briefly perused the education requirements for psychologists to prescribe medications, so someone correct me if I'm off.

IMHO, you need a residency to be able to prescribe on the order of a physician. While I do have a tremendous respect for psychologists, psychiatric medications require a medical foundation. Will a psychologist be able to treat serotinergic syndrome? How about NMS?

IMHO, psychologists prescribing medications need some type of medical oversight more than academic. They would need a residency like training program. If they didn't have that, they'd have to have physician oversight to prescribe.

You'd be comfortable being the managing attending for a patient with NMS in the ICU?

 

[whopper]

You'd be comfortable being the managing attending for a patient with NMS in the ICU?

I don't think any would be given how rare it is, and that it'd be a beast a doc would encounter rarely.

But it'd be IMHO ridiculous for a psychologist to be in charge of someone with NMS. A psychiatrist treating NMS should always get that person to the medical/ICU ward, but given our medical training, we'd be in a far better position to recognize it, and start the initial treatments while giving the IM docs a sitrep, and smooth the interface between psyche unit to medicaul unit.

 

[billypilgrim37]

You'd be comfortable being the managing attending for a patient with NMS in the ICU?

90% of it is dumping lots of fluids, stopping neuroleptics, and crossing your fingers while listening to the beeps of the ventilators around the unit.

Of course, the other 10% is what determines if the pt will actually make it, but ya know.

 

[Faebinder]

You'd be comfortable being the managing attending for a patient with NMS in the ICU?

Sometimes, it's that early shot of dantrolene with bromocriptine can make the difference...

Further... are sure you they can recognize NMS vs. Rhabdomyolosis of a restrained psychotic patient or a straight uo Dystonic Reaction of the neuroleptic drug?

 

[Solideliquid]

Sometimes, it's that early shot of dantrolene with bromocriptine can make the difference...

Further... are sure you they can recognize NMS vs. Rhabdomyolosis of a restrained psychotic patient or a straight uo Dystonic Reaction of the neuroleptic drug?

There is certainly some overlap in symptoms and lab findings but I'd think you would want to look for elevated temp, stiffness, WBC, and AMS in the NMS diagnosis.

I didn't ask how you determine or treat NMS, I simply asked if a psychiatrist would manage an NMS patient in the ICU setting. Sure we would be essential as a consultant but in most cases management of the patient would pass to the ICU physician.

 

[ThinkTooMuch]

Just as much justified in slamming the entire field of psychiatry based on the bad performance of one or even a few bad psychiatrists.

Oregon may have their reasons for doing what they are doing. There is a nationwide shortage of psychiatrists. The move to allow psychologists to prescribe may be one of desperation & a lesser of evils.

Its also one that the pharm companies in general have endorsed since it will up their distribution.

Most psychologists I've met don't want prescribing power.

If anyone here is against psychologists prescribing, and see it as a war, don't see it as if a borderline in a black & white splitting manner. Several psychologists agree they should not be able to prescribe, and if offered the oppurtunity would not take it. The pharm companies are also pushing & lobbying to prescribe, but your friendly neighborhood drug rep which is paid to kiss your butt, and give you a free dinner at a 5 star restaurant isn't letting you know this, so naturally the psychiatrists aren't getting mad at the pharm companies.

id like to clear up this myth. sorry if its off topic. there is no 'shortage' of psychs, at least no number wise. The distribution is just terrible. So to be accurate I think we should refer to it for what it is, a distribution problem of psychiatrist. (maybe something more elegant , i cant think right now been up 30 hours).

 

[whopper]

there is no 'shortage' of psychs, at least no number wise. The distribution is just terrible.

True, but shortages do exist in several places across the country to the point where this is something that needs to be examined on a national level.

So I do think it is correct of you to point out the distribution. Just that the distribution not very good on a national level.

 

[masterofmonkeys]

In a medically straightforward pt, I'd rather have a psychologist do the prescribing than an NP or PA. And about on par with a PCP.

At least it'll be by someone with the training and the inclination to get a thorough psych history and actually address the interpersonal, psychodynamic, and cognitive-behavioral issues at work.

 

[BobA]

In a medically straightforward pt, I'd rather have a psychologist do the prescribing than an NP or PA. And about on par with a PCP.

At least it'll be by someone with the training and the inclination to get a thorough psych history and actually address the interpersonal, psychodynamic, and cognitive-behavioral issues at work.

Shouldn't they at least be supervised?

Also, I see things like schizophrenia as outside the range of most non-medically trained personal. The drugs are too powerful, and the lack of a residency makes me uncomfortable.

 

[masterofmonkeys]

Shouldn't they at least be supervised?

Also, I see things like schizophrenia as outside the range of most non-medically trained personal. The drugs are too powerful, and the lack of a residency makes me uncomfortable.

well PAs and NPs are supposedly supervised as well. Doesn't actually work out that way most of the time. And someone should probably supervise a PCP who thinks xanax is an appropriate long-term medication for anyone who says they get anxious.

I doubt we're going to see anyone doing schizophrenia and bipolar outside of psychiatry for a while.

For one thing, outside of the research psychologists, most clinical psychologists (that I know) don't have too strong an interest in that kind of thing.