For our resident psychologists

[il Padrino Ute]

Originally Posted by Archaea

After reading these displays, I feel cheated in my education. Even though I spent seven glorious years in college, and have often studied other matters thereafter, much of my day is spent reading over a mundane deed of trust, advising on a joint revocable trust and informing a client that "no, I don't believe you should give all your assets to your stripper daughter so she can hold them for you."

It would have been intellecutally enjoyable to have been a Renaissance man around the turn of the Twentieth Century. The breadth of knowledge of some here is quite simply aweinspiring, from Lebowski's clarity on engineering issues to SIEQ's philosophical understanding, to Jay's and Indy's statistical abilities, it amazes me how people can be aware of so much, that my education barely even touched upon. All we need are som chemists, physicists, a few more computer studs, and we'd be complete. Well not really, but I enjoy the topics discussed.

Yeah, but how many of these smart guys could ever hit a 90 mph slider?

[danimal]

Originally Posted by MikeWaters

I agree with you that psychologists pursuing prescribing rights is stupid. Mainly because it doesn't differentiate what you do from what I do. And who would choose to see the lesser trained person for meds? It would erase the profession to some degree. Not to mention that I don't think a one semester course is suffiencient to understand comorbid illnesses (physical) and their associated treatments which may interact with psych meds. Recipe for disaster.

My program tries to produce clinicians that aren't into 15 minute med-checks. I think they succeed for the most part.

I think there is a role for medication management practices. If these folks didn't exist, many people would not be able to afford treatment. And a lot of people aren't interested in therapy.

I have a patient that has tried therapy with me and another doc. He just wants the panic attacks to go away (they have). He needs refills. And he couldn't afford 50min therapy anyway.

I agree that prescription privileges for psychologists is really dumb. Unfortunately for both psychology and psychiatry, it's going to happen. It's not if, but when. The flood gates have opened and everybody is losing their turf. Psychiatrists will lose their turf to psychologists, who will lose their turf to social workers, who will lose their turf to trained monkeys.

While it is a huge mistake for psychologists to prescribe, you better believe I will be the first person in line to get it. The profession will become two-tiered and those who can't prescribe will become irrelevant. At that point it becomes about being able to make a decent living.

[Zulu451]

Reading this post makes me thank the Lord that I am surgeon! I would rather have sharp objects shoved into my eyeballs and blood pouring out my ass than do what you guys do.

[MikeWaters]

Originally Posted by danimal

I agree that prescription privileges for psychologists is really dumb. Unfortunately for both psychology and psychiatry, it's going to happen. It's not if, but when. The flood gates have opened and everybody is losing their turf. Psychiatrists will lose their turf to psychologists, who will lose their turf to social workers, who will lose their turf to trained monkeys.

While it is a huge mistake for psychologists to prescribe, you better believe I will be the first person in line to get it. The profession will become two-tiered and those who can't prescribe will become irrelevant. At that point it becomes about being able to make a decent living.

I wonder what it has been like for psychologists prescribing in NM and LA. I can imagine that the insurance premiums skyrocket. Prescribing lithium, depakote, tegretol, zyprexa, Haldol IM, clozapine etc. is no trivial matter. And I find it ludicrous that someone with no medical training for the most part could be expected to learn what a MD spends 8 years working on, in one 3 credit course.

I think if the floodgates opened, you would see a lot fewer people going into psychiatry. You would have largely foreigners and the dregs of US medical schools. At least until an equilibrium is established. I think that means that overall, mental healthcare suffers.

Psychiatrists should punish states that adopt this. By leaving. States that value psychiatrists will not follow. It will only make the poor poorer. It's not like New Mexico and Louisiana are known for their vibrant medical scene.

If you wanted to Danimal, you could move to Louisana and New Mexico, poised to move to the first liveable state that also allowed psychologists to prescribe.

Another point. In some practices psychologists work with MD's, and the psychologist prescribes. Meaning that the psychologist says take this medicine, and the MD signs off on it, without even seeing the patient. I think this is unethical, and I would advise any patient in this situation to find a new provider.

I know someone who saw a psychologist for depression in such a practice. She was told she was probably having seizures, a MRI was suggested, and the psychologist prescribed medicine. Run like hell from these people!!!

[MikeWaters]

Originally Posted by Zulu451

Reading this post makes me thank the Lord that I am surgeon! I would rather have sharp objects shoved into my eyeballs and blood pouring out my ass than do what you guys do.

I wouldn't count out this scenario in your current job. If you make it to Iraq and google maps has given you the wrong directions.

[Archaea]

As if mental health care doesn't have enough problems without psychologists prescribing. Wow. I've fought locally that turf battle but it appears the psychiatrists will lose medication management. I'm sorry to hear that.

We will become nothing but a bunch of medicated zombies. Great, next thing you know, chiropractors will start orthopedic surgery.

[danimal]

Originally Posted by MikeWaters

I wonder what it has been like for psychologists prescribing in NM and LA. I can imagine that the insurance premiums skyrocket. Prescribing lithium, depakote, tegretol, zyprexa, Haldol IM, clozapine etc. is no trivial matter. And I find it ludicrous that someone with no medical training for the most part could be expected to learn what a MD spends 8 years working on, in one 3 credit course.

My understanding is that you would need more extensive bio/neuro training, like a year or two postdoc, but I don't really know the details.

[MikeWaters]

I looked up New Mexico, and I guess it's about 1 years worth of courses.

In other words, 1/8th training of a MD psychiatrist.

I agree with the notion that if a psychologist wants to prescribe, he/she should pursue NP, PA, or MD. PA can be as little as 2 years.

PAs are whole nother ball of wax. I wouldn't see a PA in place of a psychiatrist. But I'm sort of a snob. When I went to the plastic surgeon, I became very concerned that I might end up seeing their PA (for small cyst). Luckily I didn't. If the PA wants to tell me that my wound isn't infected, and put a bandaid on me, that's fine. But manage something complex? No thanks.

Granted, there are probably PAs out there that are better than many of the worst MDs. I'm just wary of watering down the training to the degree that we end up teaching medicine at Devry and trucker schools.

[danimal]

Originally Posted by MikeWaters

I looked up New Mexico, and I guess it's about 1 years worth of courses.

In other words, 1/8th training of a MD psychiatrist.

I agree with the notion that if a psychologist wants to prescribe, he/she should pursue NP, PA, or MD. PA can be as little as 2 years.

PAs are whole nother ball of wax. I wouldn't see a PA in place of a psychiatrist. But I'm sort of a snob. When I went to the plastic surgeon, I became very concerned that I might end up seeing their PA (for small cyst). Luckily I didn't. If the PA wants to tell me that my wound isn't infected, and put a bandaid on me, that's fine. But manage something complex? No thanks.

Granted, there are probably PAs out there that are better than many of the worst MDs. I'm just wary of watering down the training to the degree that we end up teaching medicine at Devry and trucker schools.

I agree that getting the additional degree is a much better way to go about it. There will always be people with lesser eduction who do better than the more highly educated, but I'm with you -- when in doubt go to the person with the most training.

[OhioBlue]

Originally Posted by MikeWaters

I wonder what it has been like for psychologists prescribing in NM and LA. I can imagine that the insurance premiums skyrocket. Prescribing lithium, depakote, tegretol, zyprexa, Haldol IM, clozapine etc. is no trivial matter. And I find it ludicrous that someone with no medical training for the most part could be expected to learn what a MD spends 8 years working on, in one 3 credit course.

I think if the floodgates opened, you would see a lot fewer people going into psychiatry. You would have largely foreigners and the dregs of US medical schools. At least until an equilibrium is established. I think that means that overall, mental healthcare suffers.

Psychiatrists should punish states that adopt this. By leaving. States that value psychiatrists will not follow. It will only make the poor poorer. It's not like New Mexico and Louisiana are known for their vibrant medical scene.

If you wanted to Danimal, you could move to Louisana and New Mexico, poised to move to the first liveable state that also allowed psychologists to prescribe.

Another point. In some practices psychologists work with MD's, and the psychologist prescribes. Meaning that the psychologist says take this medicine, and the MD signs off on it, without even seeing the patient. I think this is unethical, and I would advise any patient in this situation to find a new provider.

I know someone who saw a psychologist for depression in such a practice. She was told she was probably having seizures, a MRI was suggested, and the psychologist prescribed medicine. Run like hell from these people!!!

To be fair, nobody is suggesting a mere 3-credit course to cover it. The ideas I have seen suggest several courses dedicated just to psychopharm, and several hundred hours of supervised practice before being able to 'certify.' As Danimal said, the perception among psychology as a whole is that whether or not we like it, it's coming.

I agree with you on every other thing you've said though. A large part of my dissertation research focused on this very topic, RxP as they call it for psychology. I've read or perused countless arguments, articles, studies, etc on the topic, and I have the same opinion now that I did before I knew much about it. It's just a bad idea, and the implications on both applied and philosophical levels for my discipline are quite disconcerting to me. Thankfully, I disagree with Danimal on one point--this won't make non-prescribing psychologists irrelevant, simply because there are so many psychologists who either agree strongly with me, or who have no interest in going through the hassle to get that privilege. I don't think the numbers of psychologists pursuing this privilege will actually be all that high, at least not for a long time.