Oregon wants prescribing rights for Psychologists

[psychforme]

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.

I think absolutely no one is worried about psychiatrists being out of work since the supply of psychiatrist is way too limited. What is worrisome is faux "doctors" prescribing potent drugs. If a faux "doctor" would consult me because they can't handle their own **** I would be furious. I would also call a lawyer and be a witness in the trial DETERMINED to put the faux doctor out of business for good.

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[Solideliquid]

^

Yeah, you are going to far.

 

[ronin12]

Have you ever seen truck driver or cab driver getting a crash course to become a airline pilot or Paralegal to be allowed crash course of law.
for heavens sake we are talking about treating living human beings.
I am absolutely amazed with the level of indifference people have towards this very important issue. Psychologists have lost a significant amount of respect in my eyes for pushing for this unethical, unprofessional demand to prescribe meds. The whole system of getting into medical school and later residency becomes irreverent when people from all sorts jump onto the band wagon of becoming "pseudo medical providers". Literally they are playing with the lives of unassuming and innocent patients.
"It is very simple if you want to prescribe meds and qualify for the prestige and responsibility of a physician then "GO TO MED SCHOOL".

How about psychiatrist demanding to be neurosurgeons or neurologist with 1 years crash course and it goes all around among all the specialty training . their standards become irreverent when doors to treat patients are open to virtually every one.

let me state one thing to all for and against. there is nothing special what psychologist does, which a social worker or therapist doesn't , except neuropsych testings. medical knowledge of all of them is as rudimentary as my knowledge about aircraft designs, despite my obsession with aircrafts.

regarding limited scope of their practice, wait and see there is no stopping, just like today's mid level providers are treating everything, in my experience i never had a voluntary 2nd opinion from them except the pt requesting change of providers or something is screwed and needs fixing.

one more reality check" The state where I am working salary for NP's or psychiatrist is almost similar, especially in rural areas. so "Surprise"!!!!!.
psychologist would not be different, they want 15 min med check to make bucks, rather this notion of one stop shop for therapy and med management. totally Ludicrous.

 

[Therapist4Chnge]

let me state one thing to all for and against. there is nothing special what psychologist does, which a social worker or therapist doesn't , except neuropsych testings. medical knowledge of all of them is as rudimentary as my knowledge about aircraft designs, despite my obsession with aircrafts.

You lost all credibility with the above, as you are stating your ignorance of an entire field of work.

 

[Bluemirage]

The whole system of getting into medical school and later residency becomes irrelevant when people from all sorts jump onto the band wagon of becoming "pseudo medical providers". Literally they are playing with the lives of unassuming and innocent patients.
"It is very simple if you want to prescribe meds and qualify for the prestige and responsibility of a physician then "GO TO MED SCHOOL".

one more reality check" The state where I am working salary for NP's or psychiatrist is almost similar, especially in rural areas. so "Surprise"!!!!!.
psychologist would not be different, they want 15 min med check to make bucks, rather this notion of one stop shop for therapy and med management. totally Ludicrous.

The points you have made here are exactly why I am feeling alittle concerned about choosing psychiatry as a specialty and prompted my questions I had posted earlier in post#21. (See below). Your views on why psychologists want to push for RX rights agree with the powerpoint lecture I have attached in my previous post (given by a PhD Psychologist from the University of Minnesota). I don't want to come across as disrespecting the Psychology profession (they have an important role in providing psychotherapy and neuropsych testings). However, given the extremely loose standards that the proposed 2 years of pharmacological training seem to be, it's hard not to be somewhat concerned for the safety of the patients and the long-term vitality of psychiatry as a medical specialty. What do you psychiatry attendings and residents think?

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:

 

[ronin12]

You lost all credibility with the above, as you are stating your ignorance of an entire field of work.

I could care less about getting a credibility certificate.
my point of view is simple there is no significant difference in "MEDICAL KNOWLEDGE" between, therapists, psychologists and SW.
when I say "MEDICAL" it means knowledge taught in med school not in a psychology school.

 

[ronin12]

The points you have made here are exactly why I am feeling alittle concerned about choosing psychiatry as a specialty and prompted my questions I had posted earlier in post#21. (See below). Your views on why psychologists want to push for RX rights agree with the powerpoint lecture I have attached in my previous post (given by a PhD Psychologist from the University of Minnesota). I don't want to come across as disrespecting the Psychology profession (they have an important role in providing psychotherapy and neuropsych testings). However, given the extremely loose standards that the proposed 2 years of pharmacological training seem to be, it's hard not to be somewhat concerned for the safety of the patients and the long-term vitality of psychiatry as a medical specialty. What do you psychiatry attendings and residents think?

the professional security of psychiatry as a specialty?

it wont's be an apocalypse, but you will have many more people claiming to be "medical providers". please review modern day VA health system.it will give you good reality check about how worthwhile being a "physician or Psychiatrist" is.

-the future professional and practice dynamics between psychologists and psychiatrists?

I doubt it will change would be same as with NP's or other mid level providers.
-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)?

Pt's don't die but combination of meds, unnoticed medical issues , do occur and usually referred to psychiatrists if things get out of hand just befor eapoclypse, so never reported. it is job of psychiatrist to document and report these issues to relevalent professional boards.,but no one does that.
-salary of psychiatrists?

will be affected, i am witnessing in my state, which ironically has shortage of psychiatrists but have plenty of midlevels.

 

[Therapist4Chnge]

my point of view is simple there is no significant difference in "MEDICAL KNOWLEDGE" between, therapists, psychologists and SW.

when I say "MEDICAL" it means knowledge taught in med school not in a psychology school.

I would say there is a difference if someone goes through a 2 years MS program.

-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)?

Citation?

Pt's don't die but combination of meds, unnoticed medical issues , do occur and usually referred to psychiatrists if things get out of hand just befor eapoclypse, so never reported. it is job of psychiatrist to document and report these issues to relevalent professional boards.,but no one does that.

Citation?

I'd think with 4-5 years of aggregate data from NM & LA, in addition to 10+ years from military prescribing...SOMETHING would have been published/cited if what you assert was even remotely accurate. I come from a world of research, and while you seem to have a plethora of generalizations and opinions at your disposal, I have yet to see a single piece of research data supporting your views. There have been multiple studies supporting the safety and efficacy of RxP Psychologists.

 

[ronin12]

I would say there is a difference if someone goes through a 2 years MS program.



Citation?



Citation?

I am basing these opinions upon my observations ,I think you did not read my previous posts.

there are studies cited by mid level providers that they are as good as physicians,but outcome measures of these studies needs proper scrutiny, rather accepting them on face value.

 

[Therapist4Chnge]

there are studies cited by mid level providers that they are as good as physicians,but outcome measures of these studies needs proper scrutiny, rather accepting them on face value.

I'm not talking about mid-level provider studies, I'm talking about researching involving RxP Psychologists.....

I agree that studies should be reviewed, and from what I've seen....the current data out there is pretty strong in support in regard to safety and effectiveness for RxP Psychologists.

 

[whopper]

You lost all credibility with the above, as you are stating your ignorance of an entire field of work.

Oh boy, please everyone remain civil.

Therapist4Change, I very much agree that psychologists are on a different level than psychiatrists, social workers & therapists.

I also agree in your comments to defend the field of psychology.

Ronin--please remember that we as psychiatrists are just as much justified in bashing the entire field of psychology for the actions of a few as are Scientologists who try to bash psychiatry for the actions of the few psychiatrists they can find who aren't doing their jobs well.

there is nothing special what psychologist does, which a social worker or therapist doesn't , except neuropsych testings.

That I do not agree with, in fact several M.D.s have argued the same thing against psychiatrists. That we really don't do anything other than just push pills which any PCP could be doing when a patient starts "whining". Of course several of those same doctors shut up when they get a case they think is too complex. Then they'd beep me and in a state of emotional shock "James, please help me, I got a suicidal patient in my office, I don't know what to do!"

I can tell you from experience that I couldn't have won quite a few court cases it weren't for a psychologist doing testing---testing that I am as of now not qualified to do, and no general psychiatry program teaches this type of testing as far as I'm aware.

I'd think with 4-5 years of aggregate data from NM & LA, in addition to 10+ years from military prescribing...SOMETHING would have been published/cited if what you assert was even remotely accurate

I was at a presentation, the NJPA's annual award presentation of 2008 (or was it 2007? I don't remember), where they did present the psychologist presenting med data. Unfortunately I don't have the the lecture memorized. The lecture didn't present the data in a manner backing prescription power for psychologists, though one could also argue that it may have been biased, after all is the was NJ Psychiatric Association.

 

[ronin12]

I would like to look at the data.

"there is nothing special what psychologist does, which a social worker or therapist doesn't , except neuropsych testings. "

i guess i phrase this one wrong, i meant back ground medical knowledge, but it came up as I am trying to undermine psychologist skills, which I am definitely not.

Again I learned basics of neuropsych testings during my residency so was able interpret the tests and it was OK'd by psychologists as well.

 

[whopper]

I would like to look at the data.

Fair, and lets be scientific about this.

From NAMI--an organization that I think you, I, and most psychologists would think would be objective, for the patient and not showing a conflict of interest.
http://www.nami.org/Template.cfm?Se...tManagement/ContentDisplay.cfm&ContentID=8375

Overall from NAMI's data which did overview some of the data mentioned above from Therapist4Change, psychologists did do pretty well prescribing psychotropic medications however it had the following limitations...

The ACNP study revealed that the majority of psychologists trained by the DoD to prescribe medications treated patients in outpatient clinics rather than hospitals

Outpatient clinics patients are more stable & usually in a state where psychotropic meds are not to the level where it can cause medical complications. There is a major difference with a patient on Citalopram 20mg Qdaily vs Clozapine 600mg/day, Depakote 2000mg/day & Lithium 1200mg/day.

Training: Most graduates of the DoD program expressed strong support for a two year program like the one they completed, emphasizing the importance of at least one year of supervised clinical training.

Those psychologists prescribing required extra training. Not just any psychologist could prescribe.

Clinical supervisors reported no adverse patient outcomes resulting from treatment provided by psychologists who completed the PDP program. However, clinical supervisors unanimously expressed the opinion that graduates of the PDP program were weaker in terms of their medical expertise than psychiatrists. They also noted that graduates were aware of their limitations and did not hesitate to ask for advice, seek consultation or refer patients to psychiatrists when necessary.

The GAO projected that the DoD will spend somewhat more (7% higher) on its 10 prescribing psychologists than it would have spent on providing services with a more traditional mix of psychiatrists and psychologists.

The GAO concluded that the PDP program did not substantially improve the medical readiness of the Department of Defense. The GAO particularly emphasized that the program would not enhance the wartime readiness of the military because "psychotropic drugs are not generally the treatment of choice in combat and thus prescribing authority would not be in great demand." The GAO acknowledged that the peacetime capacity of the Department of Defense to provide medical treatment might be "modestly enhanced" as a result of the program.

It should be noted, however, that the human resource limitations that are today so pervasive in public mental health systems may not be as prevalent in the Department of Defense, which employed approximately 400 psychiatrists and 400 psychologists at the time of the 1999 GAO report.

And there was a benefit.

Effectiveness and Safety: Although many of the supervising clinical psychiatrists had reservations about the appropriateness of affording psychologists prescribing privileges, they unanimously rated the quality of care provided by these psychologists as good to excellent. Some supervisors reported that graduates brought a unique combination of psychopharmacology and behavioral expertise to their programs that many of the psychiatrists in these programs lacked.

I'd be lying & unobjective if I tried to claim that psychologists don't know more than us psychiatrists in some aspects. In some aspects they actually do know more (as a general rule--not an individual rule) because their training does involve several courses & measures we medical doctors do not have to take such as Sensory & Perception, Social Psychology, etc.

Overall, based on the above study, 1) I'd say there is no extreme benefit to having psychologists being able to prescribe 2) psychologists prescribing actually costs the system more 3) psychologists prescribing do need the extra training 4) psychologists prescribing still need psychiatric oversight.

That is based on the 1999 figures. The NAMI website acknowledges that today's stituation does have differences.

Overall my opinion is not changed. Psychologists are a valuable practitioners & colleagues, but based on the above, they'd still need psychiatric oversight if given prescription power. Their utilization, if used would have to be on a much more limited level vs psychiatrists.

Overall I'm still against psychologists getting prescription power unless it'd be limited as I mention above & in my previous posts. Under no circumstances should a non-M.D. being doing C/L psychiatry, or prescribing medications that require lab monitoring, which is pretty much all of them.

If you want to fight in the prescription power debate, call up the Oregon APA (both of them, psychiatric & psychological). Personally I'd stay out of it. There probably are several local factors that I'm ignorant of that may be influencing the decision process.

 

[whopper]

Not surprisingly, the state and federal chapters of the American Psychiatric Association and American Psychological Association have worked strenuously and expended considerable resources in opposition or support respectively of these legislative initiatives

Taken from the above wesbite. From my understanding, this issue has become deeply political between both APAs. Add to that, the pharm industry throwing money at this situation, while kissing our butts doesn't make it any better.

This issue fellow psychiatrists is not as simple as us vs the psychologists, and taking that perspective IMHO really just hurts patients, while degrading us as a profession & as individual practitioners. If we adopt an us vs them attitude to the personal level, it diverts us from our greater mission of helping those in need of mental health services.

If we fight, do so appropriately, and not against other psychologists in a personal manner. The psychologists working with you on a daily basis probably do not back prescription power. The pharm rep giving you the free dinner is part of an organization has more to gain & profit. There is a bigger picture here. If you really want more psychiatric representation, if anything this is more reason to join the APA if you're not already a member--the psychiatric one that is.

 

[Bluemirage]

the professional security of psychiatry as a specialty?

it wont's be an apocalypse, but you will have many more people claiming to be "medical providers". please review modern day VA health system.it will give you good reality check about how worthwhile being a "physician or Psychiatrist" is.

-the future professional and practice dynamics between psychologists and psychiatrists?

I doubt it will change would be same as with NP's or other mid level providers.
-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)?

Pt's don't die but combination of meds, unnoticed medical issues , do occur and usually referred to psychiatrists if things get out of hand just befor eapoclypse, so never reported. it is job of psychiatrist to document and report these issues to relevalent professional boards.,but no one does that.
-salary of psychiatrists?

will be affected, i am witnessing in my state, which ironically has shortage of psychiatrists but have plenty of midlevels.

Thanks for taking the time to answer my questions and offering your perspectives as a practicing attending. The situation does not sound as bad as I had thought. I just hope that this doesn't turn into a situation like Anesthesiology is in with the big push from CRNA's for more independent rights.

 

[Ollie123]

I would like to look at the data.

"there is nothing special what psychologist does, which a social worker or therapist doesn't , except neuropsych testings. "

i guess i phrase this one wrong, i meant back ground medical knowledge, but it came up as I am trying to undermine psychologist skills, which I am definitely not.

Again I learned basics of neuropsych testings during my residency so was able interpret the tests and it was OK'd by psychologists as well.

I'm somewhere in between neutral and against RxP for psychologists, it waivers on a daily basis I'm training clinically, but I'm interested in a research career so the debate is largely academic for me. I'm unlikely to even do much therapy in my career, let alone get extra training so I can prescribe

I do think the approach is entirely wrong...there are certain groups within psychology that seem to be vying to lower the standards on a regular basis, and there seems to be some overlap between them and the RxP crowd. In other words...the question no longer seems to be "How can we train psychologists to safely and effectively prescribe", and instead is "What is the minimum amount of training we can require to get these laws passed". Its by no means all of them, but unfortunately the bad ones are often the loudest. To me, a more logical solution would be to 1) Increase incentives for psychiatrists to move into underserved areas and 2) Work WITH psychiatry to figure out how psychologists can improve access to psychiatric medications. If number two leads to limited prescribing after extensive training and careful supervision than so be it. I'm not convinced its the best answer, but nor am I convinced that one needs to be a psychiatrist in order to sign off on refills of low doses of SSRI's. I don't think psychologists have any business asking to prescribe the more hardcore meds.

I did want to address two points though:

1) Our training in medicine is obviously not even close to that of physician's, for obvious reasons (its not what we went ot school to do!). However, I think you underestimate the amount of exposure to medicine many of us get in psychology. Save for medical social workers who have been in the field for 30 years, I'd bet on the psychologist having sizably more medical knowledge any day of the week, especially one specializing in health psych.

2) Before making comments about psychology as a whole, please keep in mind that the RxP supporters do not by any stretch speak for the field as a whole. I doubt they even represent a majority.

 

[whopper]

Pretty much every psychologist at my own institution don't think psychologists should be able to prescribe. That's about 15 out of 15.

Pt's don't die but combination of meds, unnoticed medical issues , do occur and usually referred to psychiatrists if things get out of hand just befor eapoclypse, so never reported. it is job of psychiatrist to document and report these issues to relevalent professional boards.,but no one does that.
-salary of psychiatrists?

Agree with this Ronin.

I think a psychologist without medical training prescribing even a monotherapy antipsychotic would be a terrible thing. Does that psychologist have any training in following diabetes, HTN, or Metabolic syndrome?

How would that psychologist be able to interpret labs that need to be ordered with Lithium, Depakote, Carbamazepine, or Trileptal? What would that psychologist do for a patient who needed Lithium & Ibuprofen at the same time?

I've seen enough psychaitrists forget about these issues, and these guys have the medical training. When adding someone without the medical training, I'm thinking this would be even worse.

 

[ronin12]

Again I am not trying to undermine or degrade profession of psychology, I disagree with people pushing for the prescription rights, as they downplaythe medical knowledge needed to practice safely and causing no harm.
I found my encounter with psychologist during residency to be intellectually stimulating .they were inspiring individuals, especially my mentor in psychotherapy.

Peace!!!!!!!!!!!

 

[Therapist4Chnge]

Overall my opinion is not changed. Psychologists are a valuable practitioners & colleagues, but based on the above, they'd still need psychiatric oversight if given prescription power. Their utilization, if used would have to be on a much more limited level vs psychiatrists.

I agree with you on this.

Overall I'm still against psychologists getting prescription power unless it'd be limited as I mention above & in my previous posts. Under no circumstances should a non-M.D. being doing C/L psychiatry, or prescribing medications that require lab monitoring, which is pretty much all of them.

I think this is where the oversight can be helpful. Lab courses are required, but I'd feel more comfortable consulting in these cases....as Clozeril and the like can be a complicated endeavor.

I do think the approach is entirely wrong...there are certain groups within psychology that seem to be vying to lower the standards on a regular basis, and there seems to be some overlap between them and the RxP crowd. In other words...the question no longer seems to be "How can we train psychologists to safely and effectively prescribe", and instead is "What is the minimum amount of training we can require to get these laws passed".

That is one of my biggest concerns. I think there is a place for compromise, but some of the "proposals" by the Pro side have been inadequate. The programs aren't quite there yet, and I hope they can beef them up AND get support from the APA, though that will probably only come state by state...and at a glacial pace.

I think a psychologist without medical training prescribing even a monotherapy antipsychotic would be a terrible thing. Does that psychologist have any training in following diabetes, HTN, or Metabolic syndrome?

How would that psychologist be able to interpret labs that need to be ordered with Lithium, Depakote, Carbamazepine, or Trileptal? What would that psychologist do for a patient who needed Lithium & Ibuprofen at the same time?

There is training for this, but I think they need more clinical hours required, as the classroom training is only a portion of what is needed to really understand many of the issues at hand.

 

[whopper]

Schizophrenia is a disorder where patients, even if not on weight/lipid gaining meds are at higher risk for metabolic disorders.

Per the American Diabetic Association, specific reccomendations need to be followed, that require the person be a medical practitioner. IMHO that creates a line that should preclude psychologist prescription power unless that psychologist were working in conjunction with an M.D.

This IMHO is pretty much black & white.

The standard of care with the administration of an antipsychotic is for the following be monitored.

1. Personal and family history of obesity diabetes, dyslipidemia, hypertension, or cardiovascular disease

2. Weight and height (so that BMI can be calculated)

3. Waist circumference (at the level of the umbilicus)

4. Blood pressure

5. Fasting plasma glucose

6. Fasting lipid profile

7. EKG

A psychologist being able to prescribe meds may be allowable under the law-if passed in the specific state, but does that allow the psychologist to order labs which by the standard of care must be drawn for an antipsychotic to be prescribed? And if so, do the laws state that this would make a psychologist qualified to interpret the labs & EKG?

The training guidelines I've seen train psychologists in psychopharmacology, & pathophysiology, but is it enough to make the person clinically competent to interpret labs?

If psychologists aren't given these same powers & training--> then they must be working in conjunction with an M.D. who must then perform these duties or they would be violating the standard of care. Why then is a psychologist even needed for prescription when the M.D. can do it?

If I were a psychiatrist in a state that passed a law that allowed a psychologist to prescribe an antipsychotic without M.D. oversight, I can see that as a legal loophole. There's a standard of care--that by the law has to be followed, but the legislation allows people to prescribe meds without being able to order & interpret labs which is the standard of care? That doesn't make sense. A legal challenge could then be brought up to dissolve a psychologist's ability to prescribe unless this was addressed in the law.

And similarly the same must be done with other meds as I mentioned above that require labwork-lithium, carbamazepine, trileptal, Depakote etc.

I've superficially perused the Oregon law, and it only offers a very superficial level of training in several things required to be learned that M.D.s learn on a far more sophisticated level. E.g. it only requires psychologists to have clinical experience with the above (physical exams, medical history taking etc) while working under an M.D. or N.P. for some time, but no academic training or testing in it. NPs & PAs that have prescribing power are supposed to pass standardized examination as part of their curriculum, not just follow somebody for a few months. No where did I see that it qualifies psychologists to order or interpret labs (unless I missed it. If I did someone point that out).

Psychopharmacology & Pathophysiology are part of the curriculum, but as many of us MD/DOs know, those simply aren't enough to interpret labs. The daily & constant barrage of a structured residency program, where residents are frequently tested on them is what really makes us competent in interpreting labs, not just working under a doctor in a nonstructred setting.

That opens several legal problems. Most, actually all psychiatric medications by the standard of care require that labs be drawn before meds are started. Psychologists already work with M.D.s and work as a team, and the M.D. listens to the psychologist input and considers that when choosing a medication.

If there were a malpractice suit, the plaintiff lawyer could put the psychologist prescriber in a very difficult position. He could question the legitimacy of the psychologist prescriber's medical knowledge by giving the person a plethora of EKGs & labs & demand that the prescriber interpret them, the plaintiff lawyer could demand the prescriber to describe medical disorders related to psychotropic med use, and demand it be on a level that a medical professional such as an MD/DO/NP/PA would have to be able to describe. The lawyer could start grilling the prescriber about NMS, Serotinergic Syndrome, Hypertensive Crisis, Diabetic Ketoacidosis, Diabetes Insipidus or several other disorders. With the level of medical training the Oregon law specifies, I wonder how many psychologist prescribers could successfully answer these if on the stand.

And that is one of the main reasons why so many of my psychological colleagues would not want to be able to prescribe--because they can foresee that happening, and don't want to be put under that level of scrutiny, nor would many of them feel they could successfully answer those questions.

 

[Bluemirage]

Schizophrenia is a disorder where patients, even if not on weight/lipid gaining meds are at higher risk for metabolic disorders.

A psychologist being able to prescribe meds may be allowable under the law-if passed in the specific state, but does that allow the psychologist to order labs which by the standard of care must be drawn for an antipsychotic to be prescribed? And if so, do the laws state that this would make a psychologist qualified to interpret the labs & EKG?

The training guidelines I've seen train psychologists in psychopharmacology, & pathophysiology, but is it enough to make the person clinically competent to interpret labs?

If psychologists aren't given these same powers & training--> then they must be working in conjunction with an M.D. who must then perform these duties or they would be violating the standard of care. Why then is a psychologist even needed for prescription when the M.D. can do it?

If I were a psychiatrist in a state that passed a law that allowed a psychologist to prescribe an antipsychotic without M.D. oversight, I can see that as a legal loophole. There's a standard of care--that by the law has to be followed, but the legislation allows people to prescribe meds without being able to order & interpret labs which is the standard of care? That doesn't make sense. A legal challenge could then be brought up to dissolve a psychologist's ability to prescribe unless this was addressed in the law.

And similarly the same must be done with other meds as I mentioned above that require labwork-lithium, carbamazepine, trileptal, Depakote etc.

I've superficially perused the Oregon law, and it only offers a very superficial level of training in several things required to be learned that M.D.s learn on a far more sophisticated level. E.g. it only requires psychologists to have clinical experience with the above (physical exams, medical history taking etc) while working under an M.D. or N.P. for some time, but no academic training or testing in it. NPs & PAs that have prescribing power are supposed to pass standardized examination as part of their curriculum, not just follow somebody for a few months. No where did I see that it qualifies psychologists to order or interpret labs (unless I missed it. If I did someone point that out).

Psychopharmacology & Pathophysiology are part of the curriculum, but as many of us MD/DOs know, those simply aren't enough to interpret labs. The daily & constant barrage of a structured residency program, where residents are frequently tested on them is what really makes us competent in interpreting labs, not just working under a doctor in a nonstructred setting.

That opens several legal problems. Most, actually all psychiatric medications by the standard of care require that labs be drawn before meds are started. Psychologists already work with M.D.s and work as a team, and the M.D. listens to the psychologist input and considers that when choosing a medication.

If there were a malpractice suit, the plaintiff lawyer could put the psychologist prescriber in a very difficult position. He could question the legitimacy of the psychologist prescriber's medical knowledge by giving the person a plethora of EKGs & labs & demand that the prescriber interpret them, the plaintiff lawyer could demand the prescriber to describe medical disorders related to psychotropic med use, and demand it be on a level that a medical professional such as an MD/DO/NP/PA would have to be able to describe. The lawyer could start grilling the prescriber about NMS, Serotinergic Syndrome, Hypertensive Crisis, Diabetic Ketoacidosis, Diabetes Insipidus or several other disorders. With the level of medical training the Oregon law specifies, I wonder how many psychologist prescribers could successfully answer these if on the stand.

And that is one of the main reasons why so many of my psychological colleagues would not want to be able to prescribe--because they can foresee that happening, and don't want to be put under that level of scrutiny, nor would many of them feel they could successfully answer those questions.

Awesome post! Thanks for taking the time to type up this well-thought out post on this psychologist RX issue.

 

[Solideliquid]

HUGE post....

I hope you don't mind I didn't quote the whole thing. I have a question about what you said. So basically a psychologist who goes through the training to prescribe still needs to work under an MD to write prescriptions? Doesn't that mean that if something goes wrong and it goes to court, that the plaintiff would go after the MD for damages since he/she is responsible for overseeing the psychologist?

 

[whopper]

So basically a psychologist who goes through the training to prescribe still needs to work under an MD to write prescriptions? Doesn't that mean that if something goes wrong and it goes to court, that the plaintiff would go after the MD for damages since he/she is responsible for overseeing the psychologist?

No. THat's my point. This law would allow psychologists to prescribe on their own--nullifying the need for an M.D.

But by the standard of care, you need an MD/DO to order & interpret labs before psychiatric meds are started.

So in effect, this law allows someone to practice in a manner that violates the standard of care, unless that law specifically states that it does allow a psychologist to order & interpret labs or it states that the psychologist must work in conjunction with a liscenced MD/DO who will do so. If a psychologist still needs to be bound by an MD/DO to interpret labs-that nullifies the need for a psychologist to prescribe--because then an MD/DO can prescribe the psychotropic med anyway.

If a the psychologist were to ask an MD/DO to interpret labs, with that MD/DO knowing it will lead to the psychologist prescribing a medication, that MD/DO will likely not cooperate with the psychologist prescriber because of what you mentioned--it can open them up to a lawsuit.

I've perused the law (though not in the fine tooth comb manner, so if someone saw something allowing for the ordering of labs, please let me know) to see if it allowed psychologist prescribers to order & interpret labs, and didn't see that in the law.

If they can't order or interpret labs, they'd be violating the standard of care by prescribing most if not all psychotropic medications.

When legal situations like this happen, where 2 laws can contradict, legal challenges can cause one of the laws to be nullified. Even if it weren't nullified, it'd open psychologist prescribers with any bad outcome to a malpractice suit scenario I mentioned--> where the plaintiff lawyer/prosecutor could have a field day with a psychologist prescriber.

Unless those issues were clarified, I wouldn't reccomend any psychologist go through the additional training programs to prescribe medications. If one were to do so, I could see their prescription power possibly being taken away in a matter of months to years--depending on whether someone is brave & bold enough to challenge the law. If the law went into effect, and it weren't challenged, I can see some lawyers & forensic psychiatrists becoming very wealthy, waiting for the first malpractice suit against a psychologist prescriber in their state, using the same arguments I mentioned. It'd be a realistic possibility because the passing of a law for psychologists to prescribe would be on the radar of every malpractice laywer & psychiatrist in the state.

That is not stated as a threat to any future psychologist prescribers. I consider psychologists colleagues. This is the same exact situation that psychologists at my workplace tell me can happen, and why they wouldn't pursue prescription ability. Its the same reason why I don't practice outside of psychiatry, even though I have a medical liscence that allows me to do so.

 

[edieb]

I am from Louisiana and the law does allow psychologists to order and interpret labs. However, psychologists receive extra training in these procedures.

Psychologists can prescribe all psychiatric meds, including mood stabilizers, anti-psychotics, stimulants, anxiolytics, antidepressants, hypnotics, et cetera and do so across all settings, including inpatient centers, hosptials, et cetera.

In fact, prescribing psychologists are on staff at Children's Hospital in New Orleans and the heads of psychiatry at the main state hospital and developmental center in the state (Central State Hospital and Pinecrest Developmental Center) are PhD psychologists.

So I guess these laws do allow psychologist to take psychiatrists' jobs.

 

[ronin12]

I am from Louisiana and the law does allow psychologists to order and interpret labs. However, psychologists receive extra training in these procedures.

Psychologists can prescribe all psychiatric meds, including mood stabilizers, anti-psychotics, stimulants, anxiolytics, antidepressants, hypnotics, et cetera and do so across all settings, including inpatient centers, hosptials, et cetera.

In fact, prescribing psychologists are on staff at Children's Hospital in New Orleans and the heads of psychiatry at the main state hospital and developmental center in the state (Central State Hospital and Pinecrest Developmental Center) are PhD psychologists.

So I guess these laws do allow psychologist to take psychiatrists' jobs.

this is very interesting, that's the point i have been making all along. there is no stopping once this law is passed, as it provides literally full scope of practice to psychologist, and field of psychiatry becomes irreverent. you don't need expensive psychiatrist to hire once you have plenty of "pseudo medical providers" to serve the purpose.
unbelievable!, ironically USA is the only country which allows this kind of non sense. you just have to have political power in order to bypass medical standards and make a medical profession (Psychiatry) look irreverent.

 

[maranatha]

I am from Louisiana and the law does allow psychologists to order and interpret labs. However, psychologists receive extra training in these procedures.

Psychologists can prescribe all psychiatric meds, including mood stabilizers, anti-psychotics, stimulants, anxiolytics, antidepressants, hypnotics, et cetera and do so across all settings, including inpatient centers, hosptials, et cetera.

In fact, prescribing psychologists are on staff at Children's Hospital in New Orleans and the heads of psychiatry at the main state hospital and developmental center in the state (Central State Hospital and Pinecrest Developmental Center) are PhD psychologists.

So I guess these laws do allow psychologist to take psychiatrists' jobs.

I am not necessarily opposed to prescribing rights for some of the more "benign" psychotropics such as SSRI's, but to extend it to anit-psychotics, stimulants, anxiolytics, and mood stabilizers is, quite frankly, alarming. These medications can be very dangerous and have so many drug interactions that, in my opinion, a medical degree is necessary.

 

[benjee]

I am from Louisiana and the law does allow psychologists to order and interpret labs. However, psychologists receive extra training in these procedures.

Psychologists can prescribe all psychiatric meds, including mood stabilizers, anti-psychotics, stimulants, anxiolytics, antidepressants, hypnotics, et cetera and do so across all settings, including inpatient centers, hosptials, et cetera.

In fact, prescribing psychologists are on staff at Children's Hospital in New Orleans and the heads of psychiatry at the main state hospital and developmental center in the state (Central State Hospital and Pinecrest Developmental Center) are PhD psychologists.

So I guess these laws do allow psychologist to take psychiatrists' jobs.

I would wonder how far down the training that psychologists received??even the law allow them to prescribe.When a provider prescribe a medication , he/she needs to assess the pt mentally and medically,reviews EKGs, labs..etc. I wonder how much the training that non-mds received that can replace totally 4 yrs of medical education and 4 yrs of residency training including internal medicine and neurology .Somehow, I feels the law allow the existence of non standard of care .

 

[Bluemirage]

I would wonder how far down the training that psychologists received??even the law allow them to prescribe.When a provider prescribe a medication , he/she needs to assess the pt mentally and medically,reviews EKGs, labs..etc. I wonder how much the training that non-mds received that can replace totally 4 yrs of medical education and 4 yrs of residency training including internal medicine and neurology .Somehow, I feels the law allow the existence of non standard of care .

Well apparently these states feel that only 300 hours of study (some of which can be distant learning) and 100 supervised patient encounters is enough (the total training time less than half of the training that the department of defense gave their psychologists and 30% less than the training time for PA's/NP's). Seems like the powerful lobby groups like pharma companies/pro-RX psychologists have the power to determine new standards of care that have nothing to do with patient safety and well-being.

 

[ronin12]

Well apparently these states feel that only 300 hours of study (some of which can be distant learning) and 100 supervised patient encounters is enough (the total training time less than half of the training that the department of defense gave their psychologists and 30% less than the training time for PA's/NP's). Seems like the powerful lobby groups like pharma companies/pro-RX psychologists have the power to determine new standards of care that have nothing to do with patient safety and well-being.

I am very interesting to know the change in financial compensation for prescribing psychologists in Louisiana. As it all boils down to money, if there is significant increase in their income,then there will be flood of new psychologists getting into this, and they could care less whether they feels qualified or not.
Then this is a financial red flag for psychiatry. I do not buy the argument it will not affect psychiatry financially. as I mentioned before in my state there is not a significant difference between Np's and Psychiatrists salaries, despite labeled as psychiatrist shortage state.

 

[notdeadyet]

as I mentioned before in my state there is not a significant difference between Np's and Psychiatrists salaries, despite labeled as psychiatrist shortage state.

Why all the attention on how much the NPs make? Does it matter?

It seems that a lot of times when there are physician-discussions about these issues of things like nurse anesthesists, nurse practitioners, PAs, etc., there's always finger pointing to "Look how much they're making!" I can see the relevance if average salary of psychiatrists in this area is dropping, but I wonder how important it is if another field's salary is rising.

Is compensation for psychiatrists in these states dropping faster than they are nationally? That would be more telling...

 

[ronin12]

Why all the attention on how much the NPs make? Does it matter?

It seems that a lot of times when there are physician-discussions about these issues of things like nurse anesthesists, nurse practitioners, PAs, etc., there's always finger pointing to "Look how much they're making!" I can see the relevance if average salary of psychiatrists in this area is dropping, but I wonder how important it is if another field's salary is rising.

Is compensation for psychiatrists in these states dropping faster than they are nationally? That would be more telling...

In an idealistic worlds, salaries, compensations should not be a factor in a choice of medical profession and commitment to serve. But ground realities are different. i will see how you will feel once you finish your residency and have net loan of 250K.
today's US health system is all about insurance, HMO's and market forces, which determine how you will earn your living and support a family after 10 to 12 years of hard work and financial obligations.
Unfortunately the multiple factors you mention in your post do affect these issues. almost all current med students will face the consequences of changing dynamics of US health care system. These are fundamentals of market forces. There still exists compensation difference between big cities and small towns or undeserved areas, which will gradually diminish with gradual infusion of midlevels, np's, psyhologistsr pescribers.

This is my observation( I dont have any student loans or other financial obligations)

 

[notdeadyet]

In an idealistic worlds, salaries, compensations should not be a factor in a choice of medical profession and commitment to serve. But ground realities are different. i will see how you will feel once you finish your residency and have net loan of 250K.

My loan debt isn't affected by how much an NP, PA or psychologist make.

I'm sweating paying off that loan, trust me. I'm very conscious of issues related to salary. But like I asked in my post: what's that got to do with what the psychologist makes?

Unfortunately the multiple factors you mention in your post do affect these issues. almost all current med students will face the consequences of changing dynamics of US health care system. These are fundamentals of market forces. There still exists compensation difference between big cities and small towns or undeserved areas, which will gradually diminish with gradual infusion of midlevels, np's, psyhologistsr pescribers.

Actually, following through on your logic, we should hope that midlevels earn more and more money. In fact, the more they are earning, the less attractive it will be for them to be offered a role traditionally reserved for psychiatrists.

So let's hope they start earning more than us. Think how much easier it will be to find jobs!

 

[Therapist4Chnge]

Well apparently these states feel that only 300 hours of study (some of which can be distant learning) and 100 supervised patient encounters is enough (the total training time less than half of the training that the department of defense gave their psychologists and 30% less than the training time for PA's/NP's). Seems like the powerful lobby groups like pharma companies/pro-RX psychologists have the power to determine new standards of care that have nothing to do with patient safety and well-being.

I know 1 year of supervised training under an MD/DO is needed after the academic work is completed before a prescribing psychologist can sit for licensure. I know some programs require the 100 pts to graduate from the academic side (which I find ridiculously low).....but it isn't nearly sufficient for licensure at the state level.

As for the "distance learning" aspect....I am COMPLETELY against any program that allows it, as I believe it is a disservice to students. (I'll spare the online learning rant....but suffice to say I think it shouldn't be allowed at the graduate level).

In regard to the lab work....additional training is provided in labs and assessment. IMHO I think more clinical hours would help enhance the academic side, but whether or not those hours are increased....it is TBD. I think more hands-on hours under direct supervision would really help strengthen the programs and provide more peace of mind that the training effectively produces quality prescribers.

 

[ronin12]

My loan debt isn't affected by how much an NP, PA or psychologist make.

I'm sweating paying off that loan, trust me. I'm very conscious of issues related to salary. But like I asked in my post: what's that got to do with what the psychologist makes?

Actually, following through on your logic, we should hope that midlevels earn more and more money. In fact, the more they are earning, the less attractive it will be for them to be offered a role traditionally reserved for psychiatrists.

So let's hope they start earning more than us. Think how much easier it will be to find jobs!

actually your are confused about real world there is no slot reserved for psychiatrists, especially in ost rural out pt community clinics. you did not get what I am trying to say, majority of mid levels don't's think that way, they firmly believe they are on equal footings as far as knowledge, skills and clinical expertise are concerned. they do practice independently so lines are blurring between these professions. It means the percieved need for psychiatrists is diminishing in the presence of midelevels who claimed to offer same services, so goes the competitiveness of psychiatrist . yes both are linked with each other. I dont know how to make it simpler then this

 

[ProRealDoc]

You psychiatrists need to learn from the anesthesiologists' mistakes. Once you open the door to midlevels or paraprofessionals who think they are just as good as medical doctors, you will be doomed.

Fight all these scope of practice expansions to the death and do not let these 'psychiatrists' wanna-be's take your field.

Contribute to your political action committee and hire lobbyists to fight these quacks at the state and federal levels.

Medicine as a whole is under attack by non-physicians who are hell-bent in achieving through legislation what they were not able to achieve through education.

 

[notdeadyet]

actually your are confused about real world there is no slot reserved for psychiatrists, especially in ost rural out pt community clinics. you did not get what I am trying to say, majority of mid levels don't's think that way, they firmly believe they are on equal footings as far as knowledge, skills and clinical expertise are concerned. they do practice independently so lines are blurring between these professions. It means the percieved need for psychiatrists is diminishing in the presence of midelevels who claimed to offer same services, so goes the competitiveness of psychiatrist . yes both are linked with each other. I dont know how to make it simpler then this

None of this has anything to do with my question: what does any of this have to do with how much money midlevels make?

I get you your fear of midlevels encroaching on psychiatrists. I get your fear that it may impact patient care. I just disagree with the focus paid to "look how much they're earning!"

If there is any link between their earning more and your earning less, I'd be interested in seeing it. But please don't feel the need to reiterate your worries about mid-levels. I get this. You've been very clear.

 

[Bluemirage]

None of this has anything to do with my question: what does any of this have to do with how much money midlevels make?

I get you your fear of midlevels encroaching on psychiatrists. I get your fear that it may impact patient care. I just disagree with the focus paid to "look how much they're earning!"

If there is any link between their earning more and your earning less, I'd be interested in seeing it. But please don't feel the need to reiterate your worries about mid-levels. I get this. You've been very clear.

I think what was ronin was trying to say is that as salaries increase for psychologists RXing (with very little extra effort compared to attending medical school), many more psychologists are going to jump on the bandwagon and do the same. Like Ronin said, they will claim to be providing mental health care "at the same level as psychiatrists" hence driving down the perceived shortage of psychiatrists and cause a decrease in their salaries (via the market forces he referred to). Prorealdoc makes a good point. Look at what has happened to anesthesiology. As CRNA's gained more independence, higher increases in salary, the perceived need for anesthesiologists have decreased along with their salaries.

 

[notdeadyet]

I think what was ronin was trying to say is that as salaries increase for psychologists RXing (with very little extra effort compared to attending medical school), many more psychologists are going to jump on the bandwagon and do the same. Like Ronin said, they will claim to be providing mental health care "at the same level as psychiatrists" hence driving down the perceived shortage of psychiatrists and cause a decrease in their salaries (via the market forces he referred to). Prorealdoc makes a good point. Look at what has happened to anesthesiology. As CRNA's gained more independence, higher increases in salary, the perceived need for anesthesiologists have decreased along with their salaries.

Ah, I see. Thank you, that makes more sense.

I'd be curious to see data on this as it becomes available. I wonder if you can really track the salary of anesthesiologists peaking due to CRNAs. Whenever salaries drop, fields tend to try to point fingers (anesthesiologists--> CRNAs, radiologists--> offshore, etc.), but I wonder how much of it is just the markets correcting themselves.

Most fields in medicine seems to be complaining about the relative drops in salaries and increases in hours. What do the other fields without midlevel encroachment blame it on?

 

[ronin12]

None of this has anything to do with my question: what does any of this have to do with how much money midlevels make?

I get you your fear of midlevels encroaching on psychiatrists. I get your fear that it may impact patient care. I just disagree with the focus paid to "look how much they're earning!"

If there is any link between their earning more and your earning less, I'd be interested in seeing it. But please don't feel the need to reiterate your worries about mid-levels. I get this. You've been very clear.

frankly I am really surprised you did not get what i am saying. they compete with physicians on every level .it does not matter whether they make less or more then psychiatrists. they bring down the salaries for the physicians in either way because they flood the market. it is much easier to become a NP's or psychologist prescribers then a physician .
They are readily available and recruited and given near similar salaries for psychiatrists in rural areas. I have never seen a place where someone fired a NP or mid level inorder to hire the psychiatrist.so they even occupy places of better salaries for psychiatrist bringing down the need to hire a psychiatrist.

 

[notdeadyet]

frankly I am really surprised you did not get what i am saying. they compete with physicians on every level .it does not matter whether they make less or more then psychiatrists.

Gotcha. I was confused when you pointed out above that psychologists are starting to make almost as much as psychiatrists in your area. I wondered why that was brought up and what the relevance was. Apparently it doesn't really matter.

they bring down the salaries for the physicians in either way because they flood the market. it is much easier to become a NP's or psychologist prescribers then a physician .

Sure, that part makes sense.

Thanks for the clarification.

 

[ronin12]

Gotcha. I was confused when you pointed out above that psychologists are starting to make almost as much as psychiatrists in your area. I wondered why that was brought up and what the relevance was. Apparently it doesn't really matter.

actually their higher salaries do matter, then more of them have incentive of becoming mid level providers,flooding the market and further bringing down the salaries. their are no controls over number of NP's or psychologist RX as opposed to limited residency slots for physicians.

 

[whopper]

Contribute to your political action committee and hire lobbyists to fight these quacks at the state and federal levels.

The APA is the best organization I know of that does this.

Getting back to psychologists being able to order & interpret labs, if this is allowable, wow, I'd consider mounting a legal challenge to it in the manner I mentioned.

300 hrs of clinical experience in a nonstructured (non-residency) setting (they only need to be under an MD/DO/NP who might not provide much teaching depending on that practitioner) is ridiculous IMHO. Let's see that's the equivlanet of 3.5 weeks of residency, minus the structured setting a residency provides. That's enough to make someone competent to interpret labs?

Most residents I see only become competent after months of doing labs, in a structured residency setting. Even after doing it for months, some residents--it wasn't enough for them. A PGY 2 still knew far more in interpreting labs vs a PGY I at 6 months.

And if they can prescribe antipsychotics, and interpret labs, then that creates a standard where several others will--> with this little amount of training. Remember, by ADA guidelines, the labs that need to be ordered are to take into account metabolic disorders. So now psychologists are experts in that area as well? HTN, Diabetes, Metabolic Syndrome, hyperlipidemia, heart attack, stroke?

 

[edieb]

Not to be incendiary, but psychologists, who have doctorates, are hardly "mid-level providers." NPs and PAs are masters level. Psychologists are responsible for many, if not most, of the innovations in the mental health field. For example, DBT and most of the research into FAS were done by psychologists.

Second of all, I don't know why some of you think you are so much better than psychologists when your own field is dying a slow death and, as a whole, standards for admission into psychiatry residencies are laughable. Just look at your boards for verification of this. At the medical school I work at, not one psychiatry resident went to a US medical school. As the DOT said, she had to fill all 20+ slots with FMGs because they cannot get US med students to fill the psychiatry slots. Doctoral-level psychology programs are MUCH more selective than medical schools, as a whole, and MUCH MUCH more selective than psychiatry residencies. So who are the "quacks?"

 

[billypilgrim37]

Not to be incendiary

right...

 

[TheWowEffect]

Not to be incendiary, but psychologists, who have doctorates, are hardly "mid-level providers." NPs and PAs are masters level. Psychologists are responsible for many, if not most, of the innovations in the mental health field. For example, DBT and most of the research into FAS were done by psychologists.

Second of all, I don't know why some of you think you are so much better than psychologists when your own field is dying a slow death and, as a whole, standards for admission into psychiatry residencies are laughable. Just look at your boards for verification of this. At the medical school I work at, not one psychiatry resident went to a US medical school. As the DOT said, she had to fill all 20+ slots with FMGs because they cannot get US med students to fill the psychiatry slots. Doctoral-level psychology programs are MUCH more selective than medical schools, as a whole, and MUCH MUCH more selective than psychiatry residencies. So who are the "quacks?"

This is such a ridiculous post that it does not deserve a response but I will take the plunge anyway. Especially implying that FMGs, who fill many residency spots, are equivalent to "quacks" is way off-base. I am sure you will have the same opinion about so many FMGs/IMGs who fill many Internal Medicine and its subspecialties, and increasingly taking more spots in surgery, radiology etc. More FMGs getting into psychiatry, IM, FM has nothing to do with quality of FMGs but rather the simple demand for higher paying specialties among US graduates, who justifiably get preference in these specialties being from US and being better versed in the local system.

 

[maranatha]

Not to be incendiary, but psychologists, who have doctorates, are hardly "mid-level providers." NPs and PAs are masters level. Psychologists are responsible for many, if not most, of the innovations in the mental health field. For example, DBT and most of the research into FAS were done by psychologists.

Second of all, I don't know why some of you think you are so much better than psychologists when your own field is dying a slow death and, as a whole, standards for admission into psychiatry residencies are laughable. Just look at your boards for verification of this. At the medical school I work at, not one psychiatry resident went to a US medical school. As the DOT said, she had to fill all 20+ slots with FMGs because they cannot get US med students to fill the psychiatry slots. Doctoral-level psychology programs are MUCH more selective than medical schools, as a whole, and MUCH MUCH more selective than psychiatry residencies. So who are the "quacks?"

I'm not sure anyone was putting down your superior intellectual abilities... I think the issue most people have is with the level of medical training.

 

[BobA]

Not to be incendiary, but psychologists, who have doctorates, are hardly "mid-level providers." NPs and PAs are masters level. Psychologists are responsible for many, if not most, of the innovations in the mental health field. For example, DBT and most of the research into FAS were done by psychologists.

Second of all, I don't know why some of you think you are so much better than psychologists when your own field is dying a slow death and, as a whole, standards for admission into psychiatry residencies are laughable. Just look at your boards for verification of this. At the medical school I work at, not one psychiatry resident went to a US medical school. As the DOT said, she had to fill all 20+ slots with FMGs because they cannot get US med students to fill the psychiatry slots. Doctoral-level psychology programs are MUCH more selective than medical schools, as a whole, and MUCH MUCH more selective than psychiatry residencies. So who are the "quacks?"

There are many smart PhD's in Medieval French Literature, but that doesn't make them fit to read EKG's and prescribe Haldol Decanoate.

Psychologists just don't have the medical training.

Moreover, mid-levels are at least supervised. At a minimum psychologists should be supervised by an MD/DO.

 

[Therapist4Chnge]

At a minimum psychologists should be supervised by an MD/DO.

If there was consultation required, would you be okay with psychologists prescribing?

 

[Bluemirage]

Not to be incendiary, but psychologists, who have doctorates, are hardly "mid-level providers." NPs and PAs are masters level. Psychologists are responsible for many, if not most, of the innovations in the mental health field. For example, DBT and most of the research into FAS were done by psychologists.

Second of all, I don't know why some of you think you are so much better than psychologists when your own field is dying a slow death and, as a whole, standards for admission into psychiatry residencies are laughable. Just look at your boards for verification of this. At the medical school I work at, not one psychiatry resident went to a US medical school. As the DOT said, she had to fill all 20+ slots with FMGs because they cannot get US med students to fill the psychiatry slots. Doctoral-level psychology programs are MUCH more selective than medical schools, as a whole, and MUCH MUCH more selective than psychiatry residencies. So who are the "quacks?"

Wow...strong words coming from someone who just two years ago was asking about switching from PhD Psych to MD because you had lost interest in pursuing the field of psychology. Doctoral-level psychology being more selective than medical school?? Please do us a favor and stop making stuff up to boost your own insecurities. We all know that there is no post-bachelor program more competitive than medicine (except maybe for top 3 law or MBA school). Not trying to say it is easy but you are exaggerating the stringency of PsyD admissions standards. Nobody is challenging psychologists' academic capabilities. I think people here are most worried about the lack stringency of psychologists' post-doctorate training in medicine/pharmacology. If there were strict standards in place where you did a complete 3 year residency along with passing USMLE steps like the MD/DDS folks, prescribing psychologists will be welcomed with open arms.

 

[whopper]

Doctoral-level psychology being more selective than medical school??

There are several great psychology programs, as alrady mentioned you can be brilliant, even be Stephen Hawking with your degrees in physics, and that doesn't mean you are competent to practice medicine.

If you have a problem with FMGs and think they are quacks, why not let your hospital know this. In fact, take it up to a level of intellectual honesty and tell the FMGs this to their face.

Wow, this is the type of post I'd expect from a troller, not someone with a 2+ year membership ribbon on their handle, who is either a doctor or on track to becoming one.