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New sticky.
Jon Snow said:What is "advanced practice?"
PublicHealth said:OK, I'll get us started....here's a great set of articles on psychologist RxP from the National Register of Health Service Providers in Psychology that sasevan posted in another forum:
http://www.nationalregister.org/TRR_online_fall2005.htm
ProZackMI said:I've said it a few times in the past, but I'll reiterate it here: I truly believe that with the appropriate training, a doctorally prepared psychologist, with advanced psychopharm and med assessment training, should be more than qualified to prescribe psychotropics.
At first, I was against this, but after doing some research, I don't think it's a bad thing and may actually help some patients who wouldn't otherwise have access to a competent mental health professional (other than an an MSW/MA).
Another point, master's level NPs and bachelor's level PAs, as well as optometrists, prescribe meds all the time and have not been through med school, and research shows that they prescribe meds more safely than many MDs and DOs (especially the IMG/FMGs). Podiatrists, pharmacists, and dentists also have full or partial RxPs and do a safe and effective job, for the most part, in prescribing meds.
With the appropriate training, why wouldn't PhD/PsyDs with additional pharm/med training be effective and safe prescribers? I think the data from NM and LA has shown that so far, so good in terms of prescribing psychologists in those states.
I still maintain that clinical psychology should move from the scientist-practitioner model (Boulder?) to the PsyD (practitioner) or Vail model. A PsyD should be a four year, post BA/BS professional degree, like the JD, MD, PharmD, DDS, DVM, OD, etc. Lose the heavy stats courses, the research courses, and focus on anatomy/physiology, pharmacology, med/psych assessment, counseling/therapeutics, psychometrics, etc.). Incorporate the pharm into the doctoral program rather than mandate a post-doc MS in psychopharm.
If a student wishes to do research, publish, and experimentation, go for a PhD rather than a PsyD.
Just my two cents. I wish you guys the best of luck in fighting for RxPs.
PublicHealth said:Prozack,
Can you copy and paste the above, edit a bit to make it sound more "official" (you're a lawyer so I have faith in you ), and then send it to legislators in your state (Michigan)? I'm sure psychologists lobbying for RxP would appreciate having an MD, JD speaking out in favor of RxP for psychologists. Rock on.
ProZackMI said:I've said it a few times in the past, but I'll reiterate it here: I truly believe that with the appropriate training, a doctorally prepared psychologist, with advanced psychopharm and med assessment training, should be more than qualified to prescribe psychotropics.
At first, I was against this, but after doing some research, I don't think it's a bad thing and may actually help some patients who wouldn't otherwise have access to a competent mental health professional (other than an an MSW/MA).
Another point, master's level NPs and bachelor's level PAs, as well as optometrists, prescribe meds all the time and have not been through med school, and research shows that they prescribe meds more safely than many MDs and DOs (especially the IMG/FMGs). Podiatrists, pharmacists, and dentists also have full or partial RxPs and do a safe and effective job, for the most part, in prescribing meds.
With the appropriate training, why wouldn't PhD/PsyDs with additional pharm/med training be effective and safe prescribers? I think the data from NM and LA has shown that so far, so good in terms of prescribing psychologists in those states.
I still maintain that clinical psychology should move from the scientist-practitioner model (Boulder?) to the PsyD (practitioner) or Vail model. A PsyD should be a four year, post BA/BS professional degree, like the JD, MD, PharmD, DDS, DVM, OD, etc. Lose the heavy stats courses, the research courses, and focus on anatomy/physiology, pharmacology, med/psych assessment, counseling/therapeutics, psychometrics, etc.). Incorporate the pharm into the doctoral program rather than mandate a post-doc MS in psychopharm.
If a student wishes to do research, publish, and experimentation, go for a PhD rather than a PsyD.
Just my two cents. I wish you guys the best of luck in fighting for RxPs.
Jon Snow said:Given what the Psy.D. system is currently, I strongly disagree.
sasevan said:Hey ProZackMI,
Great to have you here and in the psychiatry forum. As usual, you make some great points. I really hope that you maintain some presence in medicine/psychiatry evenwhile practicing law. Though I'm sure that in either endeavor you'll continue to be a great advocate.
Peace.
P.S. Best of luck on the Bar Exam
ProZackMI said:If all goes well, I'll be a lawyer if (and that's a big IF) I pass the February 06 bar exam. Xanax has helped me through 200 evidence and civil procedure questions for the last week!
I'll tell you one thing, once I move into law, I will advocate strongly for RxPs for med psychologists. However, strangely, I haven't heard much of a movement for that sort of thing here in MI. It seems most of the momentum is either on the East Coast or out West (WA, OR, HI, and CA). I think I read that MO or another similar state had a bill on the floor, but it was rejected? Anyone know more about that? I wonder if it's that the APA's lobby group isn't as strong as the optometrists and NPs?
ProZackMI said:It would require change, no doubt. The current PsyD is a quasi-professional degree. It's a hybrid between a PhD and a....JD/MD/DDS, whatever. In other words, it has characteristics of a PhD, but also has characteristics of a professional degree. I work with a woman who received her PsyD from either Pace or Rutgers (I really can't remember) and she told me she had to write a dissertation/doctoral paper, take a ton of stats classes, etc. That made me wonder, does she have a watered down PhD or a some kind of hybrid degree? There is no doctoral project or dissertation for the JD or MD or other professional doctorates.
So, you'd have to scap the current PsyD curriculum and make it more like other professional health care programs.
Year 1 - combination of advanced psychology and basic medical sciences
Year 2 - Same
Year 3- clinical psych, clinical med assessment and pharm
Year 4- more clinical psych, clerkships, simple research, pharm
PsyD + licensure exams, including pharmacology
2-3 year post doc residency in a medical/hospital setting
The PsyD in my world would be structured like the MD, DDS, OD, DPM, PharmD, DVM. First two years are mostly clinical/basic sciences. Third year is clinical. Fourth year is clinical and practical.
The PhD would be reserved for researchers only. IMO, a PhD isn't geared for practice. No offense to any PhD practitioners out there, but your doctorate is a research degree. Just my thoughts!
Zack
sasevan said:Another good post
I think that RxP will have initial success in the less urbanized (i.e., with less psychiatric presence) states as one of the main arguments for medical psychologists is to increase patient access to psychopharmacologists. Given that I think that RxP has the best chance in the South, Midwest, Southwest, and Northwest (HI also). I don't think it has a very good chance in the near future to pass in places like MA, NY, NJ, PA, FL, IL, TX, or CA. Although in the latter I believe there's a lawsuit arguing that psychiatry's opposition to RxP is a violation of psychology's right to establish/regulate its own scope without unfair interference from its business competitor (not really sure about this but its what I remember hearing from an RxP conference at APA about 2 years ago). If there is such a lawsuit and psychology were to win then likely RxP will sweep most states. Can you think of any legal angle on this?
ProZackMI said:I've said it a few times in the past, but I'll reiterate it here: I truly believe that with the appropriate training, a doctorally prepared psychologist, with advanced psychopharm and med assessment training, should be more than qualified to prescribe psychotropics.
At first, I was against this, but after doing some research, I don't think it's a bad thing and may actually help some patients who wouldn't otherwise have access to a competent mental health professional (other than an an MSW/MA).
Another point, master's level NPs and bachelor's level PAs, as well as optometrists, prescribe meds all the time and have not been through med school, and research shows that they prescribe meds more safely than many MDs and DOs (especially the IMG/FMGs). Podiatrists, pharmacists, and dentists also have full or partial RxPs and do a safe and effective job, for the most part, in prescribing meds.
With the appropriate training, why wouldn't PhD/PsyDs with additional pharm/med training be effective and safe prescribers? I think the data from NM and LA has shown that so far, so good in terms of prescribing psychologists in those states.
I still maintain that clinical psychology should move from the scientist-practitioner model (Boulder?) to the PsyD (practitioner) or Vail model. A PsyD should be a four year, post BA/BS professional degree, like the JD, MD, PharmD, DDS, DVM, OD, etc. Lose the heavy stats courses, the research courses, and focus on anatomy/physiology, pharmacology, med/psych assessment, counseling/therapeutics, psychometrics, etc.). Incorporate the pharm into the doctoral program rather than mandate a post-doc MS in psychopharm.
If a student wishes to do research, publish, and experimentation, go for a PhD rather than a PsyD.
Just my two cents. I wish you guys the best of luck in fighting for RxPs.
Solideliquid said:I'm an IMG, and it seems like you are willing to put down a population of hard working physicians to improve your cause, which is wrong.
Care to show me this research? I mean if you are going to compare prescribing patterns of optometrists, and PAs to all phsycians that's bad research.
PsychEval said:Prozack,
I have attached an application in case you may be interested in being a Collaborative Practice Associate of the American Society for the Advancement of Pharmacotherapy. The purpose of the Collaborative Practice Committee is to establish liaisons with health care professionals who are currently licensed to prescribe medications, with the goal of increasing opportunities for interdiscipilinary collaboration, research, and education. Essentially, it is for prescribing providers who support prescriptive authority for psychologists. Additionally, I suspect many RxP training programs all over the country would be interested in having a psychiatrist teach some of the coursework.
http://www.division55.org/pdf/CollaborativePracticeApplication.pdf
ProZackMI said:It would require change, no doubt. The current PsyD is a quasi-professional degree. It's a hybrid between a PhD and a....JD/MD/DDS, whatever. In other words, it has characteristics of a PhD, but also has characteristics of a professional degree. I work with a woman who received her PsyD from either Pace or Rutgers (I really can't remember) and she told me she had to write a dissertation/doctoral paper, take a ton of stats classes, etc. That made me wonder, does she have a watered down PhD or a some kind of hybrid degree? There is no doctoral project or dissertation for the JD or MD or other professional doctorates.
So, you'd have to scap the current PsyD curriculum and make it more like other professional health care programs.
Year 1 - combination of advanced psychology and basic medical sciences
Year 2 - Same
Year 3- clinical psych, clinical med assessment and pharm
Year 4- more clinical psych, clerkships, simple research, pharm
PsyD + licensure exams, including pharmacology
2-3 year post doc residency in a medical/hospital setting
The PsyD in my world would be structured like the MD, DDS, OD, DPM, PharmD, DVM. First two years are mostly clinical/basic sciences. Third year is clinical. Fourth year is clinical and practical.
The PhD would be reserved for researchers only. IMO, a PhD isn't geared for practice. No offense to any PhD practitioners out there, but your doctorate is a research degree. Just my thoughts!
Zack
Solideliquid said:I'm an IMG, and it seems like you are willing to put down a population of hard working physicians to improve your cause, which is wrong.
Care to show me this research? I mean if you are going to compare prescribing patterns of optometrists, and PAs to all phsycians that's bad research.
Solideliquid said:I'm an IMG, and it seems like you are willing to put down a population of hard working physicians to improve your cause, which is wrong.
ProZackMI said:As a physician and soon to be attorney, I have a thorough understanding of medical malpractice issues. My emphasis in law school was health care law and medical negligence. While I don't have facts and figures to share at the top of my head, I will tell you that the legal research strongly indicates that FMGs constitute the bulk of medical defendants in certain areas. Interestingly, the majority of these "physicians" are psychiatrists, pediatricians, gynecologists, and neurologists. I'm not sure why, but that is what the legal research indicates.
I'm also basing my comments on research I did for a research paper I did in law school regarding scope of practice issues in various health care professions (e.g., optometry, NPs, PAs, podiatry, etc.). As an MD, I started off wanted to read that optometrists were killing people by inappropriately prescribing a medication, not understanding a drug contraindication, etc. I wanted to see that NPs and PAs did harm by having RxPs. I was wrong and surprised. What really shocked me is to learn that IMGs do more harm than non-physician prescribers.
Also, based on my personal experience, working with many foreign medical grads who are psychiatrists, I often see inappropriate diagnoses, poor/dangerous medication choices, and frequent communication problems due to langauge barriers and poor communication skills and/or cultural differences. I have personally caught several egregious errors in prescribing and tx.
I can look up the legal sources I mentioned above and give you hard facts and figures, but suffice it to say, more harm has been done my physicians prescribing (both US trained and non-US trained) than has been done by any PHD, OD, PharmD, DDS, NP, etc. The data suggests (but is not dispositive) that foreign medical grads (mostly from India and Asia) are the worst offenders in terms of medical malpractice issues related to prescribed medications. Yes, this seems like a sweeping generalization, but that is what the research has shown. Sorry if that bothers you.
Of course, that does not mean ALL FMGs are poorly trained or dangerous. Some of the best physicians I know personally obtained their education abroad. It's a case-by-case basis, but unfortunately, the data suggests a pattern in terms of FMGs and medical negligence centered on prescribing.
Solideliquid said:I'm an IMG, and it seems like you are willing to put down a population of hard working physicians to improve your cause, which is wrong.
Care to show me this research? I mean if you are going to compare prescribing patterns of optometrists, and PAs to all phsycians that's bad research.
PsychEval said:[/B]
Hi Solid,
Im a Ph.D., and it seems like you are willing to put down a population of hard working psychologists to improve your cause, which is a losing battle. BTW, I'm sure your well versed in research.
Solideliquid said:Dear Psych,
You have me wrong on both counts! I am not opposed to psychologists prescribing meds as long as there is a well thought out education route.
On the second count, no I am not versed in research as I am a fresh medical graduate and there hasn't been time for me to swim in those waters. LOL
ProZackMI said:that the majority of harm done to patients is done by MDs and DOs. Moreover, of this group (physicians as a whole), it is the FMGs who more frequently prescribe an inappropriate medication, over prescribe, don't look at the whole medical hx, don't understand pharmacology, etc. It is the FMGs who end up harming patients, more often, than the non-physician prescribers.
Why is this? Several reasons. FMGs typically receive inferior training. They usually have 5-6 years of formal education (typically, a Bachelor's in Medicine is the degree earned without prior undergraduate training). .
psisci said:Be nice.... This is getting off topic.
ergo_sum said:What a load of self serving B.S. When I came to the U.S. I was shocked at the level of medicine I saw. Where I was trained, we were taught to think and we were expected to be knowledgable, hard working and caring. Here's what I saw in the U.S., an initial impression that has only been stregnthened in the years since:
American doctors are trained to throw a pill automatically at every complaint. They do not know how to think.
American doctors aim to please the customer, not treat the patient, as a physician should.
American doctors know how to play office poltiics and suck up to those in power - they do not care about the patients, or about what is right.
American doctors haven't got a clue about collegiality. They consistently attack one another and eat their young alive.
US doctors resemble robots, IMO. Money grubbing ones, that is.
Medicine here is far inferior to that practiced in other countries. Sure, the rooms are nicer, the instruments might be newer, and at the cutting edge of certain sub specialties, the US is undoubtedly number one. But you do not know how to be a caring, thoughtful, logical, empathic physician, a person who has dedicated their life to the health and well being of others. You know how to be slick and make money.
I have treated many patients that had been treated by American doctors, including some working at several famous Boston hospitals (MGH, Mclean). It seems at times that every single person who walks through their doors is diagnosed with Bipolar and loaded up with lamotrigine, lithium, seroquel and a bunch of other junk. This overdiagnosis of Bipolar and this rabid polypharamcy originate from the so-called "best" academic centers, and are rampant in all levels of practice.
I find your posts ridiculous and I think you are a hate mongerer. You have built up an entire thought system just to justify your own xenophobia, Mr. lawyer-doctor.
psisci said:I don't think we should be doing ECT. I think we should be able to order it when needed but not administer it...sorta like general anaesthesia.
PublicHealth said:Funny how quickly your tone and opinion changed once a lawyer reamed your ass. Go ProZack!
psisci said:For you PPR or the psychopharmacology institute would be a good option. PM me, and I can send you some links. Happy to hear you are interested in the training as that is the most important part of all of this talk of RxP in my opinion..getting psychologists some medical training.
lazure said:I'm a clinical psych doctoral student in Canada - no prescription rights anywhere on the horizon here.
lazure said:I'm a clinical psych doctoral student in Canada - no prescription rights anywhere on the horizon here. But I would like to learn about psychopharmacology, particularly as it relates to my children and adolescent clients. Where do I start? I'm capable of doing lit reviews using PubMed but I feel I need a fundamental background from somewhere. Unfortunately, my current school does not offer an overview course of pharmacology like my previous school did.
ProZackMI said:5. You are obviously a very insecure person who feels inferior to US trained docs because of your foreign medical education.
ergo_sum said:Um...you just managed to miss the entire point of my post...
I have not for one instant felt inferior...don't you get it? I came here and was appalled at what I saw...I count myself blessed for having had such a wonderful medical education.
And you ARE a xenophobe. Are you not?
ProZackMI said:This is not a place to bash American physicians, but rather, to discuss potential advances to the scope of practice of clinical psychology. If you have comments to add about clinical psychology, then make them, otherwise kindly cease and desist posting in this thread.
ProZackMI said:Nope, I'm Dutch and Norwegian.
I'm not a Xenophobe.
Here's a novel concept. If you're so appalled by the medical profession in the United States, then you should pack your stuff, buy a plane ticket back to your place of origin, and go back there to practice medicine where you can put your wonderful medical education to good use. You are an Americanophobe, to coin a new word, and your contempt for this country is patently offensive.
YOU missed my whole point, which was objective and empirical research has shown that non-physician prescribers are not a danger to the public as the AMA would have everyone believe. Additionally, more people die each year from errors/incompetence from physicians prescribing meds rather than non-physicans prescribing meds.
To me, that is a good indicator that properly trained psychologists would not pose a threat to their patients by gaining RxPs. This is not a place to bash American physicians, but rather, to discuss potential advances to the scope of practice of clinical psychology. If you have comments to add about clinical psychology, then make them, otherwise kindly cease and desist posting in this thread.
ergo_sum said:Only reason I posted here was that after you had gone on your little racist rant there, an IMG who stood up to you (even just a little) was yelled down. I was trying to show you that there can be different opinions about American Greatness, and you should not be so certain of your superiority.
Mister, you are not in charge of this thread, this is not your courtroom, and you ain't gonna tell me where I can post.
I cannot compete however with your productivity in terms of sheer word volume, and I do not intend to try.
It is easy to be nasty and racist. I see that no evidence to the contrary will sway you from your very-dearly-held-opinion. You could have a thousand eloquent, educated IMG's posting here, you could meet a thousand rude and ignorant american docs, and you would still hold on to your opinions. It is clear that I have failed in my mission here on this thread, and you will persist in spreading these malignant views.
Signing off.
Ergo_sum.
psisci said:FYI, I asked DrMOM in the MOD forum if we could get a subforum for "medical psych" discussions. She said YES, but then suggested I start with a Sticky, and see how much traffic we get. I did. To try and get traffic I posted in the psychiatry forum inviting them to post. I got slammed for doing so, so I give up. Anyhow, for those psychiatry students and posters on the psychiatry forum who do choose to come over and post any and ALL opinions on the subject, you are welcome! Let's argue our respective points respectfully.
ergo_sum said:Only reason I posted here was that after you had gone on your little racist rant there, an IMG who stood up to you (even just a little) was yelled down. I was trying to show you that there can be different opinions about American Greatness, and you should not be so certain of your superiority.
Mister, you are not in charge of this thread, this is not your courtroom, and you ain't gonna tell me where I can post.
I cannot compete however with your productivity in terms of sheer word volume, and I do not intend to try.
It is easy to be nasty and racist. I see that no evidence to the contrary will sway you from your very-dearly-held-opinion. You could have a thousand eloquent, educated IMG's posting here, you could meet a thousand rude and ignorant american docs, and you would still hold on to your opinions. It is clear that I have failed in my mission here on this thread, and you will persist in spreading these malignant views.
Signing off.
Ergo_sum.
PublicHealth said:In keeping with the topic of this thread, here's a .pdf of Tennessee psychologists' "back and forth" with Tennessee psychiatrists regarding psychologist RxP. Tennessee's mental health system is a mess!
http://www.tpaonline.org/leg/rxp.pdf
TN bill: http://www.legislature.state.tn.us/bills/currentga/BILL/SB0723.pdf
I have a feeling that Tennessee will gain prescriptive authority for psychologists this upcoming legislative cycle -- they successfully passed it through the Senate and were ONE VOTE shy of passing it through the House last cycle (http://www.tpaonline.org/leg/id155.htm). Hawaii looks promising too. Anyone else have any insight regarding legislation for psychologist RxP in these or other states?