Psychopharmacology/Advanced Practice Psychology

[WisNeuro]

Thanks for the advice. I fear it won't change my behavior. If you think turf conflicts aren't a part of medicine, you either don't work in the field, or are blind to it.

Seriously, if you ever find any real evidence against the RxP privileges, I'd love to see it. The usual fear-mongering gets old. If I want that, I'll just turn Fox News on.

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[Goobernut]

Well just to clarify, NP's don't only have "2 years" of clinical knowledge/experience.

Often they get their bachelor's in nursing (3-4 years), then might go on to the master's in nursing, then finish up with the terminal NP pathway. Mix in time off between degrees with work experience, and it comes out to closer to 10 (or more) years of "clinical experience" to arrive at their level of autonomy and Rx rights.

Yes, they have nursing experience before getting an NP, but I don't think most have two masters. You put "clinical experience" in quotes... is it clinical experience or is it not? I feel like I need to read more into that when you put it in quotes. You say "closer to 10 years" but I don't think that nursing experience should qualify as part of that "10 years of clinical experience."

 

[freemontie]

Thanks for the advice. I fear it won't change my behavior. If you think turf conflicts aren't a part of medicine, you either don't work in the field, or are blind to it.

Seriously, if you ever find any real evidence against the RxP privileges, I'd love to see it. The usual fear-mongering gets old. If I want that, I'll just turn Fox News on.

OK. You are truly ridiculous. In the future, at least stop masquerading as an unbiased observer. I'm done with this asinine thread....continue to try to convince us "RxP" is equal to Psych NPs which is equal to board certified Psychiatrists. I predict at least 10,000 more useless posts.

 

[WisNeuro]

Ah, ad hominem, I was wondering when you'd come out in full force.

 

[freemontie]

...If you think turf conflicts aren't a part of medicine, you either don't work in the field, or are blind to it.

One last thing: turf wars are a part of medicine, sure. Like a cardiologist doing stents and taking business away from old-school CT surgeons. But...guess what? you AREN'T a part of medicine. Shocker!

(But that shouldn't be an insult. You're *supposedly* a psychologist, an expert on fixing behavioral problems with talk therapy....though your comments on this thread make it seem wanting....)

 

[WisNeuro]

I don't do therapy my friend. I bet you'd like me in real life. We should go grab a beer and watch a game, whaddya say?

 

[Therapist4Chnge]

One last thing: turf wars are a part of medicine, sure. Like a cardiologist doing stents and taking business away from old-school CT surgeons. But...guess what? you AREN'T a part of medicine. Shocker!

(But that shouldn't be an insult. You're *supposedly* a psychologist, an expert on fixing behavioral problems with talk therapy....though your comments on this thread make it seem wanting....)

That is such a narrow view of what a psychologist does...that is akin to saying that a psychiatrist only prescribes medications for depression. SSRIs and SNRIs for all!! Psychologists are first and foremost scientists and we believe in data. So...where is the data that prescribing psychologists are not adequately trained?

And do I have to mention the accounts of prescribing psychologists leaning on medical consults in the first place? The holes in that argument are so many and so large as to make the bucket non-existant.

Just to be clear...in research the plural of anecdote is not data.

 

[PsyDr]

Crap! I guess all the neuropsychologists on medical staff in neurosurgery, psychiatry, and neurology should be alerted.

Btw: since we're resorting to ad hominems: that was a pretty awesome rape fantasy you posted in another thread.

Everyone: I woukd encourage you to look through this posters history of being argumentative in a wide variety of subjects.

 

[smalltownpsych]

One last thing: turf wars are a part of medicine, sure. Like a cardiologist doing stents and taking business away from old-school CT surgeons. But...guess what? you AREN'T a part of medicine. Shocker!

(But that shouldn't be an insult. You're *supposedly* a psychologist, an expert on fixing behavioral problems with talk therapy....though your comments on this thread make it seem wanting....)

Assessment, diagnosis, and treatment is not "medicine"? I guess the other members of the medical staff here at our hospital should stop referring patients to us and maybe I don't have to go to any more of the medical staff meetings to hear radiology and ortho go at it again.

To keep up with the ad hominem, maybe the difficulty that you have understanding what we do is that you aren't a doctor *supposedly*.

 

[freemontie]

No, I wouldn't consider a psychologist, even one that works in a hospital, to be a medical practitioner. But if you want to call what you do practicing medicine, than go right ahead, assuming you don't live where laws specifically prohibit it.

 

[smalltownpsych]

No, I wouldn't consider a psychologist, even one that works in a hospital, to be a medical practitioner. But if you want to call what you do practicing medicine, than go right ahead, assuming you don't live where laws specifically prohibit it.

Of course, the practice of medicine is a legally protected term, that's why they use the more generic label of healthcare provider since only an MD or DO can legally practice medicine. I was just questioning what you though the distinction was. It was not my intent to say that a psychologist practices medicine.

 

[Fan_of_Meehl]

I wonder what the 'vs. profession' latin phrase equivalent to ad hominem would be?

'ad professionem?'

seems applicable

 

[freemontie]

Crap! I guess all the neuropsychologists on medical staff in neurosurgery, psychiatry, and neurology should be alerted.

Btw: since we're resorting to ad hominems: that was a pretty awesome rape fantasy you posted in another thread.

Everyone: I woukd encourage you to look through this posters history of being argumentative in a wide variety of subjects.

This is just despicable. You went back and edited your previous post, adding these last two lines thinking I wouldn't see this and thus wouldn't get to respond to your slander.

That rape fantasy concerned a study that found nearly a third of college men surveyed said they would use force to obtain sex if there were no consequences but only 13% would rape if there were no consequences. I wrote what I thought was the different scenario going through their minds to account for that large statistical difference. I specifically acknowledged how that scenario was still, indeed, a rape and consent even then was NOT achieved. I immediately 'liked' a post where another poster said that was exactly a typical problem area with rape and consent in the minds of young men. There was more debate and ultimately another poster suggested I was incorrectly assuming the best of those surveyed. It was an off-topic discussion in this thread if anyone wants to check it out- but please keep replies to that in that thread, as per mod rules: http://forums.studentdoctor.net/thr...d-out-over-alleged-sexual-misconduct.1114473/

You are despicable for implying that I write rape fantasies for fun. As for being argumentative- we all are. We are arguing and disagreeing. And I knew going in that 99.9% of you would disagree with me since we are in the Psychology sub-forum after all. But you're tip-toeing on the line if not crossing it.

 

[erg923]

This is just despicable. You went back and edited your previous post, adding these last two lines thinking I wouldn't see this and thus wouldn't get to respond to your slander.

That rape fantasy concerned a study that found nearly a third of college men surveyed said they would use force to obtain sex if there were no consequences but only 13% would rape if there were no consequences. I wrote what I thought was the different scenario going through their minds to account for that large statistical difference. I specifically acknowledged how that scenario was still, indeed, a rape and consent even then was NOT achieved. I immediately 'liked' a post where another poster said that was exactly a typical problem area with rape and consent in the minds of young men. There was more debate and ultimately another poster suggested I was incorrectly assuming the best of those surveyed. It was an off-topic discussion in this thread if anyone wants to check it out- but please keep replies to that in that thread, as per mod rules: http://forums.studentdoctor.net/thr...d-out-over-alleged-sexual-misconduct.1114473/

You are &%(&% despicable for implying that I write rape fantasies for fun. As for being argumentative- we all are. We are arguing and disagreeing. And I knew going in that 99.9% of you would disagree with me since we are in the Psychology sub-forum after all. But you're tip-toeing on the line if not crossing it!!

Calm. Down. Its just the internet...

Nobody likes angry doctors.

 

[Therapist4Chnge]

This is just despicable. You went back and edited your previous post, adding these last two lines thinking I wouldn't see this and thus wouldn't get to respond to your slander.

To be accurate, libel is the more appropriate term, as it refers to written or printed statements/claims that are considered defamatory (per a court decision). Slander is generally limited to spoken or transient expression (i.e. gesture).

Yeah…I'm one of those grammar ppl.

 

[WisNeuro]

Honestly people, can we refocus the conversation back to the fact that there is no data against the current RxP in place?

 

[freemontie]

Calm. Down. Its just the internet...

Nobody likes angry doctors.

Therapist (Edit: meant 'Erg'), I'm definitely not a saint on the internet and I ruffle people's feathers- sometimes on purpose. Implying someone writes rape fantasies for fun implies that he's a rape supporter. You can't get more serious than that which is why it's one of the very few things that is tip toeing the line.

 

[erg923]

Therapist, I'm definitely not a saint on the internet and I ruffle people's feathers- sometimes on purpose. Implying someone writes rape fantasies for fun implies that he's a rape supporter. You can't get more serious than that which is why it's one of the very few things that is tip toeing the line.

Robet Deniro would say, in his very Robert Deniro way, "Yes, but you're getting very excited."

 

[smalltownpsych]

Calm. Down. Its just the internet...

Nobody likes angry doctors.

I am pretty sure that he is not a doctor, they usually stick to more rational concerns about adequate care as opposed to just attacking psychologists. Most medical docs appreciate what we do and some of them in rural areas even support us having prescription privileges.

 

[freemontie]

I am pretty sure that he is not a doctor, they usually stick to more rational concerns about adequate care as opposed to just attacking psychologists. Most medical docs appreciate what we do and some of them in rural areas even support us having prescription privileges.

Well, I specifically said I wasn't an MD/DO earlier in this thread. I do think medical docs appreciate what psychologists do but sincerely doubt any significant contingent of them supports non-medical practitioners having prescription privileges.

 

[smalltownpsych]

The docs in rural areas where patients don't have access to psychiatrists are much more supportive than you might think. Even in more urban areas I don't think that it is uncommon for medical docs to look to us for medication recommendations. That is a common ethical dilemma for us on how we answer those questions and maintain our scope of practice.

 

[Therapist4Chnge]

Well, I specifically said I wasn't an MD/DO earlier in this thread. I do think medical docs appreciate what psychologists do but sincerely doubt any significant contingent of them supports non-medical practitioners having prescription privileges.

Thank you for clarifying this point, as it was unclear (to me) your background. To be fair, it wouldn't be the first time I missed a detail here or there. As someone who has graduated from an RxP program and also assisted in multiple states and drafts of legislation language…the "support" question is quite dependent on speciality and location. There is far from one voice on the matter, so it isn't as cut and dry as physicians don't "support" RxP.

I agree with smalltownpsych about the support from physicians in rural areas, as I've worked/consulted in two rural areas and adequate access to prescribers is one of the biggest problems in those communities. I've also worked in a mid-sized city and large city, and the support is much more factioned by speciality. I have worked with some psychiatrists and neurologists who aren't supportive, but found neurologists, physiatrists, GPs/FPs/PCPs, who are mostly supportive. Of course…some of those who weren't supportive didn't want other physicians in other specialities to prescribe ANY psychotropics to patients they shared, so I don't feel singled out.

 

[Winged Scapula]

Everyone needs to adhere to the TOS: that means being civil, professional and mature. Insulting other users and calling them names warrant administrative action.

 

[CGOPsych]

The docs in rural areas where patients don't have access to psychiatrists are much more supportive than you might think. Even in more urban areas I don't think that it is uncommon for medical docs to look to us for medication recommendations. That is a common ethical dilemma for us on how we answer those questions and maintain our scope of practice.

I agree that one important consideration is whether psychologists should practice medicine as psychologists. That will arguably change the profession, for better or worse. When asked if they support psychologists prescribing medications under any imaginable condition, about 60 or 65 percent of our colleagues respond positively. But when the question is narrowed to asking if we should expand our scope of practice to include prescribing within psychology, the numbers fall to 26-45 percent approval. However, another debate is under what conditions psychologists should prescribe, and when the questions ask about details of the RxP proposals, then the support among psychologists falls off precipitously.

The vast majority of psychologists oppose the training standards contained in legislative bills proposed for RxP which are sponsored by APA, and for very good reason. They clearly seem inadequate to almost everyone who is allowed to know what they are. The RxP advocates never explain their proposals when lobbying for them.

In Illinois, APA's training standards were rejected in a negotiated agreement between the RxP leader and the medical people, substituting what amounts to the 5-6 years of full-time training that is required for physician assistants, including a 14-month full-time practicum. However, it is very unlikely that anyone is going to go through all that training, particularly since the result is a scope of practice far narrower than that allowed physician assistants who have the same amount of preparation.

Therefore, the APA model of training for RxP remains a massive failure, with 181 bills having failed in 26 states, and with the biggest failure yet in Illinois in 2014. Meanwhile, telepsychiatry is very successful and growing in enhancing access to psychoactive medications, as are proposals of training psychologists sufficiently to collaborate with medical providers. An alternative of cross-training psychologists to the standards of other non-physician prescribers is also gaining ground, not only with the Illinois PA standards taking precedence over the APA proposal, but the growing success that nurse practitioners have in achieving independent practice in 19 states and the District of Columbia.

 

[WisNeuro]

Therefore, the APA model of training for RxP remains a massive failure, with 181 bills having failed in 26 states, and with the biggest failure yet in Illinois in 2014. Meanwhile, telepsychiatry is very successful and growing in enhancing access to psychoactive medications, as are proposals of training psychologists sufficiently to collaborate with medical providers. An alternative of cross-training psychologists to the standards of other non-physician prescribers is also gaining ground, not only with the Illinois PA standards taking precedence over the APA proposal, but the growing success that nurse practitioners have in achieving independent practice in 19 states and the District of Columbia.

I wholeheartedly agree. I am in agreement with the idea of RxP, not so much in the implementation. As you stated, it is either inadequate, or too onerous. It seems we're at an impasse. On one side, I'd be ecstatic if the psychiatrists I worked with actually spent some time on diagnosis and considered any kind of treatment before a medication cocktail. I've seen far too many misdiagnosed individuals with "Bipolar" disorder who seem to have never had anything close to a manic or hypomanic episode, and too many people prescribed maintenance benzos. It'd be nice if someone adequately trained in the administration of both therapy and prescribing could work to find the best treatment option that incorporates actually treating the underlying disorder in the least restrictive way possible.

I could see an actual program for a kind of hybrid position. But, as many of the current options exist, I'm not wholly satisfied with any current proposal for re-specialization, on both ends of the issue.

 

[DynamicDidactic]

Idaho RxP passed out of Senate Committee 9-6

Congratulations to the powerful Idaho RxP colleagues led by the Idaho Psychological Association President Dr. Sue Farber and Executive Director for IDPA Deborah Katz who marched their Senate Bill No. 1060 to its first success yesterday!

A fourth generation Idaho-ian, Dr. Farber was a force to be reckoned with. Highly intuitive, graceful, with the years of overlapping professional and personal relationships with so many key Idaho parties, she has navigated an amazing path for RxP for Idaho! Although she herself will not be prescribing, she reported to me that she believes this is the path for psychology and wants to provide that opportunity to the next generation of psychologists!

That kind of selfless service is mirrored by everyone on her team! A leader, who leads!

Testimony was lively with expected antagonists attacks. Very positive testimonies in support of Senate Bill No. 1060 from independent practicing psychologists; social work; CEO from inpatient drug and alcohol counseling program; retired psychologist who ran large county mental health services.

And of course, our own eminent faculty member and RxP trainer, Dr. Marlin Hoover! In powerful testimony yesterday, Dr. Marlin Hoover hit a home run! Open hearted with robust non-inflammatory responses, Marlin reflected the best of us with his explanations of why we studied; what we do; and how we collaborate!

Marlin is a "Mission Multiplier" for the RxP movement. As a RxP leader, we are blessed to have him as he emanates care from "a good heart with good medicine!" He truly sets the standard of personal and professional integrity that will guide our movement in a flourishing way.

Consult, collaborate, and seek concurrence! Powerful CCC's! (We need to clone about 12 Marlin's!).

Closing argument for Pro Vote offered by attorney who has served in almost all the highest levels of judicial courts, and who authored the text of the bill. Extremely eloquent and articulate professional who clearly owned the room and the bill! He volunteered a personal fact that his family holds a 'mentally ill person on medication', that clearly softened the Representatives and became a living witness! The bill became a living document!

This prior defense attorney's presentation might be the most powerful and activating testimony I have ever heard from someone who believes in and supports us! What an honor it was to be in attendance! What an honor it was to be among this group of dedicated and gifted people who are seeking to enlarge the capacity of the professional delivery of psychology to their Idaho families and children!

Idaho Psychological Association represents the best of us!

Very exciting!

Senate Bill No. 1060 passed with a vote of 9-6. It will now go to the full Senate later this week or next week.

I have made it known that I do not support RxP for psychologists until the field rectifies a lot of the other problems we have.

At this point, I am sure the AMA will get involved, anti-RxP will concentrate their efforts and the cycle will continue.

 

[freemontie]

Wow it keeps going without any of the concerns being addressed. The Iowa proposal suggests 450 classroom hours- which sounds impressive until you realize that’s only equal to about 9-10 semester courses. Certainly much less than the didactics for any established practitioner. But more than that what is taught in these courses? As much as some of you seem to look down on the credentials of Physician Assistants you can’t simply stick RxPers in PA school courses- which require prereqs like gen bio, microbiology, human anatomy, human physiology, gen chemistry, organic chemistry, various labs. If they don't require the med pre-reqs and aren't willing to start with the basics of pre-med; what do they teach? e.g. How do they teach medical biochemistry to someone who may not have even taken high school chemistry? That's just the first problem.

 

[WisNeuro]

Aside from many of us already having all of those courses in undergrad, if they can complete master's level coursework at a reputable program in the area, I don't see how making them go back and taking a lower level undergrad class is going to magically give someone that competency. Undergraduate performance doesn't predict much beyond undergraduate GPA when you look at it as a career performance indicator.

 

[freemontie]

I don't think most Psych PhD's did the full, or even most of, the pre-med work. If they did- why not make them formal pre-requisites and teach the classes at the level of PA school? Currently the most common way to get a master's degree for RxP is online or through in-person classes 1x a month. They all give you a master's degree (in "clinical psychopharmacology") but it's far from "master's level coursework" in the sense you are arguing. I'd venture to say it's significantly lower level than undergraduate pre-med; relying on applied overviews of subjects.

 

[WisNeuro]

Most, no, but many, yes. And perhaps they are not the required pre-reqs because they are not required for competency in this area? At the level that training has taken place in DoD, NM, and LA it appears that things have worked out and the sky has not fallen.

Heck, I can't imagine they could possibly do worse with some med management than I see with most of my patients. Prescribing zolpidem for 5+years, maintenance benzos, aricept for MCI...

 

[smalltownpsych]

Most, no, but many, yes. And perhaps they are not the required pre-reqs because they are not required for competency in this area? At the level that training has taken place in DoD, NM, and LA it appears that things have worked out and the sky has not fallen.

Heck, I can't imagine they could possibly do worse with some med management than I see with most of my patients. Prescribing zolpidem for 5+years, maintenance benzos, aricept for MCI...

Although pointing to other poor treatment isn't necessarily a justification for RxP, I had to like it cause I see this everyday. As psychologists, we are acknowledged as experts in mental health assessment, research, and treatment. For anybody to say that we would take a few online classes and just start prescribing meds without sufficient expertise is an insult. Of course, there are poor psychologists out there who would practice poorly, they are already out there. I guess this goes to your point about other providers having flaws too. Some medical doctors are bad, some NPs are bad, and some PAs are bad. What the anti-RxP can't address is why a competent psychologist with education and supervised experience would have poorer outcomes than the average prescriber. Of course they don't have that info because the evidence doesn't exist.

 

[smalltownpsych]

Wow it keeps going without any of the concerns being addressed. The Iowa proposal suggests 450 classroom hours- which sounds impressive until you realize that’s only equal to about 9-10 semester courses. Certainly much less than the didactics for any established practitioner. But more than that what is taught in these courses? As much as some of you seem to look down on the credentials of Physician Assistants you can’t simply stick RxPers in PA school courses- which require prereqs like gen bio, microbiology, human anatomy, human physiology, gen chemistry, organic chemistry, various labs. If they don't require the med pre-reqs and aren't willing to start with the basics of pre-med; what do they teach? e.g. How do they teach medical biochemistry to someone who may not have even taken high school chemistry? That's just the first problem.

Idaho not Iowa. Mistakes like that when prescribing medications could be fatal. I was in charge of setting up the medication administration at a residential treatment center along with the RN who worked for me because as a psychologist part of my expertise is analyzing and designing systems to minimize human error.
I took a lot of pre-med classes since that was my first major. That point is just ridiculous. I have learned a lot more about all of these topics during the course of my psychology training except for organic chem. I'm pretty sure most practicing physicians are a little rusty on their O chem stuff and would say that it is not that relevant to their current practice. I have seen whole threads about that.

 

[bcliff]

I support RxP with the caveat that I think that there should be more stringent requirements (APA PhD and APA internship to start, maybe a limit on the number of pharmacology classes you can take online?), and I think that the postdoctoral training should be standardized as well - Perhaps a year of foundational bio/chem/etc., 2 years of more complex pharmacology? Maybe integrate some of the prereqs into doctoral programs and add it as a concentration or minor in clinical PhD programs - Isn't that kind of what the IL legislation says?

Is there research on adherence when assessment, intervention, and med management are integrated into one provider rather than two or three? I imagine there would be some positive effects of limiting the number of providers and appointments necessary to go from initial diagnosis to treatment plan, but ¯\_(ツ)_/¯

 

[freemontie]

Although pointing to other poor treatment isn't necessarily a justification for RxP, I had to like it cause I see this everyday. As psychologists, we are acknowledged as experts in mental health assessment, research, and treatment. For anybody to say that we would take a few online classes and just start prescribing meds without sufficient expertise is an insult. Of course, there are poor psychologists out there who would practice poorly, they are already out there. I guess this goes to your point about other providers having flaws too. Some medical doctors are bad, some NPs are bad, and some PAs are bad. What the anti-RxP can't address is why a competent psychologist with education and supervised experience would have poorer outcomes than the average prescriber. Of course they don't have that info because the evidence doesn't exist.

It shouldn't be considered an insult to psychologists. People in every field tend to do the least amount of education and training that's formally required of them to achieve their career goal. Believe it or not- most people understandably care more about quickly making money than gaining expertise. That's why it's naive to have low formal standards but high expectations.

 

[smalltownpsych]

I support RxP with the caveat that I think that there should be more stringent requirements (APA PhD and APA internship to start, maybe a limit on the number of pharmacology classes you can take online?), and I think that the postdoctoral training should be standardized as well - Perhaps a year of foundational bio/chem/etc., 2 years of more complex pharmacology? Maybe integrate some of the prereqs into doctoral programs and add it as a concentration or minor in clinical PhD programs - Isn't that kind of what the IL legislation says?

Is there research on adherence when assessment, intervention, and med management are integrated into one provider rather than two or three? I imagine there would be some positive effects of limiting the number of providers and appointments necessary to go from initial diagnosis to treatment plan, but ¯\_(ツ)_/¯

There are so many variables with that type of outcome research that it is really difficult to come to any conclusions. It's like some of the often cited research on various clinicians level of training or experience or modalities of treatment - too many confounds for me to give much weight to the findings. What I have seen happen is that the research tends to be either too broad (lacks internal validity) or too specific (external validity/generalizability) to be of much help. Of course, the limitations of our science is one thing that keeps me passionate about this field. If it was easy, then it would be boring.

 

[CGOPsych]

Although pointing to other poor treatment isn't necessarily a justification for RxP, I had to like it cause I see this everyday. As psychologists, we are acknowledged as experts in mental health assessment, research, and treatment. For anybody to say that we would take a few online classes and just start prescribing meds without sufficient expertise is an insult. Of course, there are poor psychologists out there who would practice poorly, they are already out there. I guess this goes to your point about other providers having flaws too. Some medical doctors are bad, some NPs are bad, and some PAs are bad. What the anti-RxP can't address is why a competent psychologist with education and supervised experience would have poorer outcomes than the average prescriber. Of course they don't have that info because the evidence doesn't exist.

I agree that it is insulting, as well as dangerous, to many people to presume that a person with no experience or education in the biomedical sciences can independently prescribe medication to all persons, of all ages, with all medical conditions, and taking all other medications based on education that consists of 30 semester hours of instruction taken online on a laptop on Sunday mornings. Those 10 courses of three semester hours each would have to cover all the fundamentals of organic chemistry, physiology, biology, etc. as well as the most sophisticated practices of treating children, adolescents, seniors, persons with chronic illnesses, pregnancies, developmental disorders, and so on and so on.

Here is one example: One of the most prolific programs selling these courses (for $14,000) purports that in 36 clock hours of online instruction, the aspiring prescriber will learn: “child/adolescent psychopharmacology, geriatric psychopharmacology (dementia, polypharmacy, and interactions between pharmacotherapy and age associated illnesses); developmental disorders; treatment of chronic pain disorders; psychopharmacological issues for individuals with chronic medical illness, victims of trauma, and patients with personality disorders.”(This is on the website of the California School of Professional Psychology, if you wish to see it.)

Now really, friends. Does anyone here believe that you can learn all this in 36 clock hours of online instruction? Psychiatrists make child/adolescent a specialization with separate boards and fellowships. "Prescribing psychologists" learn it all in 36 hours along with all those other topics. This is just one of many examples of how the details of the RxP proposals are almost absurd, and why they work hard to hide them.

Read any pro-RxP literature and you will see many references to a "Master's degree in psychopharmacology" and you will never, ever, see them admit to how that degree is earned. You may understand why when you see the nuts and bolts.

It's true that those who oppose RxP do not have data to show that these few prescribers who were educated on laptops have worse outcomes than others, and it's true that there are no data at all. This is a failure of the RxP campaign. They have had 11 years in LA and 13 years in NM to develop this data. There is no empirical evidence that these people are prescribing safely, nor that they are doing so effectively for their patients, or that allowing non-medical persons to prescribe drugs based on such an obviously inferior model compared to any other prescribers is in any way improving access to medications or improving the general mental health system. Strangely, proponents claim that it is up to opponents to gather that data, which of course is absurd. It is incumbent on those who have sought special privileges which, on their face, appear to based on dangerously inferior training, to show that what they are doing is safe and effective.

Also, please consider that the proponents, backed by millions of dollars by the APA's political wing (obtained through fraud in collecting the practice assessment, but that is another matter) would benefit tremendously if they had such data, considering that 181 of their bills have failed in 26 states, and that they just suffered a massive defeat in Illinois last year. Such data could bolster their case substantially ... and yet, no data. This seems to suggest that either they don't care about the science, or they can't produce any systematic evidence that this is safe and effective.

The more details people learn of the RxP proposals, the less they like them. Thus, the best thing for opponents to do is to simply spread the word.

 

[PsyDr]

Cgopsych: like clockwork. A bill appears, then cgopsych drops by to say it's bad.

 

[CGOPsych]

Cgopsych: like clockwork. A bill appears, then cgopsych drops by to say it's bad.

I see you complain about the frequency of my postings rather than address their content. You also are not clear on whether you actually disagree that the bill was a disaster for the RxP campaign. If you believe it was not, it may be of interest in learning your reasons.

 

[WisNeuro]

Just wondering, what set of empirical standards would you suggest to prove the safety of RxP prescribers? And, does that same evidence exist for MD's, PA, and NP's? I think there are several faulty assumptions that go unchecked in these arguments. One is that the curriculum in place for MD's is the only way that one can gain competency in this area. A second is that curriculum is safe and effective.

Now anecdotally, many of us (especially in neuropsych), can attest to gross mismanagement of medications by psychiatry, and neurology to some extent. Are they held to the same standard that RxP opponents are clamoring for?

 

[CGOPsych]

Just wondering, what set of empirical standards would you suggest to prove the safety of RxP prescribers? And, does that same evidence exist for MD's, PA, and NP's? I think there are several faulty assumptions that go unchecked in these arguments. One is that the curriculum in place for MD's is the only way that one can gain competency in this area. A second is that curriculum is safe and effective.

Now anecdotally, many of us (especially in neuropsych), can attest to gross mismanagement of medications by psychiatry, and neurology to some extent. Are they held to the same standard that RxP opponents are clamoring for?

Interesting ideas, for sure. While some may infer that the physician-level training is the only way to be competent, I certainly don't make that assumption. However, we do see physicians, PA's and APN's routinely criticized for making many poor judgments, and I see that too, despite the fact that they have far more and better training than what is proposed in the RxP bills. I would argue that the answer to that is not to reduce the training to extremely low levels so that non-medical people are allowed to practice medicine part-time. I do not think that psychologists are so superior to those medical providers that they can overcome that gross deficit in training and experience to provide higher quality care.

I'm sure you would agree that across the board, the best way to ensure quality care is through quality training. Physicians have about 20 times the training of the RxP bill, and the quality of that education and training is better. In Illinois, the Assembly mandated that prescribing psychologists get training that is the same as physician assistants (in a program accredited not by APA but by the organization that accredits PA programs), including a 14-month fulltime practicum with medical rotations. MD, PA, and APN training models do have scientific support. The IOM has reviewed the performance of APN's and endorsed their training model.

Another point to make is that these medical providers probably have about a thousand times as much experience prescribing in practice than any of the RxPers do or ever will. I'm sure you would agree that experience also enhances judgment, as a general rule.

As for empirical standards for measuring safety and effectiveness, I'm sure there are many methodologies for doing so. Expecting empirical support is not at all unreasonable. This is particularly important because the RxP advocates obtained political approval for experimenting with this model by making promises that it would help people. We haven't seen them show that they are. Their only support after all these years are some anecdotes and glowing self-assessments.

The training model of RxP is, on its face, wildly inappropriate. I have pointed out some examples of that and I think most sensible people would agree when they are given the chance to see all the details. This makes it far more important that some empirical research be used to show that it is appropriate, if so. Also, the RxP model has never been reviewed by any medical authority as to whether it is appropriate for practicing medicine. Once again, I'm sure many would agree that the approval of those who know a lot about what it takes to practice medicine would be not only helpful, but necessary when proposing to create a new class of medical providers.

 

[WisNeuro]

Well, the errors I see, I don't believe will be amleiorated by more clinical training. Rather, they appear to be driven by a complete lack of knowledge in the research and new developments of medications. Or, not understanding the difference between statistical vs. clinical significance in research studies. Training in research is sparse, and inconsistent within an MD's training. Good luck on getting that mandated and regulated across training programs.

Also, experience enhancing judgment is not all that accurate. The curve is more asymptotic. We all know the clinical vs. actuarial literature. I just think some of the criticism of RxP is disingenuous given the lack of similar evidence on the other side.

 

[mc625510]

I guess I'm just not understanding this argument..are people opposed to Rx rights for psychologists no matter what? It seems people who are anti-Rx are against the lack of training that current bills propose. I agree that taking online courses and having minimal supervision is silly. But it seems like the obvious solution that the requirements (coursework and supervision, and maybe a standardized exam demonstrating competency is drug interactions) should be made tougher.

Are those opposed to Rx rights opposed to psychologists prescribing even if they receive better training?

 

[CGOPsych]

Well, the errors I see, I don't believe will be amleiorated by more clinical training. Rather, they appear to be driven by a complete lack of knowledge in the research and new developments of medications. Or, not understanding the difference between statistical vs. clinical significance in research studies. Training in research is sparse, and inconsistent within an MD's training. Good luck on getting that mandated and regulated across training programs.

Also, experience enhancing judgment is not all that accurate. The curve is more asymptotic. We all know the clinical vs. actuarial literature. I just think some of the criticism of RxP is disingenuous given the lack of similar evidence on the other side.

"Disengenuous" means dishonest. I will assume you didn't intend to say that.

These broad complaints no doubt have some basis, but the ability to assess research is only one aspect of good clinical practice. Also, the trend in training psychologists has been to reduce the focus on science and focus on clinical practice, which is why a new clinical psychology training program accreditation program has emerged, exactly what you criticize medical training for. Cognitive research also says that people become proficient when they do something a lot, and can see the outcomes. It remains true that the best way to ensure competence in a complex profession is through proper training. Perhaps it's possible that people with no biomedical education can take 10 courses online and be educationally prepared to practice psychiatric medicine, but I think any reasonable person would want to see some proof.

 

[WisNeuro]

Disingenuous has a broader definition than mere dishonesty, I did fully mean to use that word. You assume incorrectly.

As far as the de-emphasis on research, you can look at my prior posts in a variety of settings here, I am an ardent critic of programs not training clinicians adequately in research. So, there is no hypocrisy there.

As for the RxP training, most proposals I have seen also mandate a sort of clinical practicum period under supervision. Although the Idaho bill is sufficiently vague, I'm not sure exactly what they call for. As for the call for proof, the disingenuous comment comes from demanding that from RxP, but not for other prescribers.

 

[CGOPsych]

I guess I'm just not understanding this argument..are people opposed to Rx rights for psychologists no matter what? It seems people who are anti-Rx are against the lack of training that current bills propose. I agree that taking online courses and having minimal supervision is silly. But it seems like the obvious solution that the requirements (coursework and supervision, and maybe a standardized exam demonstrating competency is drug interactions) should be made tougher.

Are those opposed to Rx rights opposed to psychologists prescribing even if they receive better training?

Excellent point. There are several levels of concern about the RxP campaign. A large number of psychologists believe that the practice of medicine should not be incorporated into psychology at all, since it entails a number of risks and changes the fundamental nature of the profession. In addition, psychologists have always had the opportunity to prescribe medication by getting cross-training, just like anyone else. And after all, APN's now practice and prescribe independently in 19 states and DC, so those who campaign for greater access to care would be smarter to set up cross-training programs for psychologists and they could have our colleagues practicing independently in those 19 states and with a good deal of independence in all others. For reasons of their own, they keep proposing these bills with very controversial training provisions, and keep losing.

The next level of concern is the training, for sure. The RxP model is indeed silly, but dangerously so because the APA is putting its money and power behind passing such bills.

In Illinois, the RxP model was repudiated completely. Instead, an agreement between the RxP campaign leader and the psychiatry people resulted in a law that essentially says that prescribing psychologists will have to get all the training of PA's. This would entail 7 undergraduate courses of basic, with labs, and 20 graduate courses that cover the same material as that of PA's, plus a 14-month full-time rotation. As noted earlier, this program would have to be accredited by the organization that accredits PA programs. No such program exists and there may never be one. This would require 5.5-6 years of full-time study, but then maybe that's what it takes to be qualified to practice medicine. Additionally, the law imposes a number of limitations on the prescribing psychologists' practice. They cannot prescribe benzodiazepines. They can't treat persons under 17 or over 65, or who are pregnant or have major medical or developmental conditions.

Many opponents of the APA's RxP campaign say that while they do not want psychologists prescribing *as psychologists*, they are more comfortable with training that equals a profession that has already been accepted and tried. The IL situation seems to meet that for the most part.

 

[PsyDr]

@cogpsych I am actually complaining that you do not participate enough in any other aspect of this forum. Only participating in the rxp debate only when legislature pops up makes you look like a troll who is trying to publish your viewpoint at politically convenient times.

Why not participate in the rest of the forum? There is much more to psychology than rxp.

 

[CGOPsych]

@cogpsych I am actually complaining that you do not participate enough in any other aspect of this forum. Only participating in the rxp debate only when legislature pops up makes you look like a troll who is trying to publish your viewpoint at politically convenient times.

Why not participate in the rest of the forum? There is much more to psychology than rxp.

"Troll" is offensive and ad hominem. I'd like to invite you to actually debate the facts rather than complain and insult.

I've never been criticized for not contributing enough to a forum. If it makes you feel better I might add my $.02 worth more often. However, I prefer to contribute on topics I feel confident I can add something to the conversation. I see too many people writing things that don't seem to make a difference. Hmm, let me think of an example ...

 

[PsyDr]

Saying something is offensive is what's called a "special case red herring fallacy". So we both have logical fallacies in our statements.

 

[WisNeuro]

I'm still wondering about the charge that RxP has to produce evidence that other prescribers don't. Why the double standard?

 

[Therapist4Chnge]

I'm still wondering about the charge that RxP has to produce evidence that other prescribers don't. Why the double standard?

Turf is a pretty glaring reason...The horses already left the barn for NPs, so it is an attempt to not allow adequately trained psychologists to also provide medication management. Boogie Man tactics and overly broad generalizations without a lick of data to support the "Danger!!" "Protect your kids!!" claims are commonplace.