[Therapist4Chnge]

Prescribing rights for clinical psychologists is a hot topic in the psychology and psychiatry worlds, though I haven't heard much from NPs. I'm curious to hear people's opinions about the topic.

Currently New Mexico, Louisiana, the US Military, and I think Gaum/Puerto Rico all have prescribing rights, with another dozen or so states with active bills in support of clinical RxP'ing.

I'm a big supporter of clinical RxP'ing, though I'm still a bit concerned about consistency in training and standards of other programs that are popping up.

I guess in a slight tangent, I'm also curious how the training varies for NPs, and if this has caused any 'real world' problems, or if it is something that people just nitpick (my school is better than your school, etc). I'm asking because I'm a bit worried that some of the training for clinical RxP training varies too much in quality.

So....

1. What do you think about clinical psychologists (with proper training) prescribing?
2. How (if at all) does NP training vary, and does this have real world implications, or is it mostly a 'my school is better than your school' argument?

-t

ps. For full disclosure, I'm in clinical psych, and I am halfway through my RxP training at a university/classroom based program.

[traumaRUs]

How timely for me...I went to Springfield last week to lobby for our APN nurse practice act which is sunsetting this July. One of the hot topics was prescribing for psychologists and pharmacists. My personal bias is that without pharmacology training and the ability to integrate a person's entire med regime, it could be extremely dangerous.

My one recent example involved a nursing home patient of mine who has end stage renal disease and is on hemodialysis. She is very much awake, alert and oriented. She was given a pill that she didn't recognize and questioned the nurse and was told it was a vitamin that the pharmacist thought she should be on. She refused it until she could talk with me at dialysis to make sure that it was okay for her take. Turns out, it had potassium in it! Big no no for most dialysis patients, her included. When I questioned the pharmacist as to his changing her med (he had exchanged the vitamin I had prescribed), he said he did it because it was cheaper!!!!! He didn't even realize that she was a dialysis patient.

So...my only complaint is that if we are going to add more prescribing folks to our patients', the patients must be highly educated and the prescribers need to know the entire reasons for other meds the pt takes.

[Therapist4Chnge]

Originally Posted by traumaRUs

So...my only complaint is that if we are going to add more prescribing folks to our patients', the patients must be highly educated and the prescribers need to know the entire reasons for other meds the pt takes.

I completely agree. I think if done right, it can help the pt get what they need, and simplify some of the run-around that happens with HMO's, etc. (Psych refers to a psychiatrist....waits 6-8 weeks, then gets a 'script, etc)

In my program I know we get an extensive amount of general pharma training, as well as the staple courses as a foundation (orgo, nuero, physiology, etc). I'd hope that becomes the standard.

Something I have noticed is that many GPs/FPs get stuck trying to manage psych cases, and they don't have the time to really go over everything bc. they need to see a certain # of pts a day, etc. Psych cases can eat up that time.

I know my plan is to just do the meds management for my private practice pts. I think having meds available as an adjunct to therapy can be a great advantage. You can see the pt. every week to monitor them, and address the issues from two sides.

-t

[mercyteapot]

I worked for 2 psychiatrists for many years and one of them summed it up best. Sure, psychologists should be able to prescribe... after they go to medical school and became physicians.

The argument that granting psychologists would circumvent the runaround HMOs give patients is actually part of the reason that I oppose these rights. I don't think that HMO should be given yet another mechanism by which to dilute the quality of care patients receive, and I just can't imagine that they'll approve any visits to psychiatrists if psychologists have prescribing rights.

[Therapist4Chnge]

Originally Posted by mercyteapot

...... dilute the quality of care patients receive

...by getting more face time with their clinician, and not waiting 6-8 weeks for a 10-15 minute appointment? 15% of psych pts get their meds from a psychiatrist....not exactly an overwhelming majority of 'quality care'.

Originally Posted by mercyteapot

and I just can't imagine that they'll approve any visits to psychiatrists if psychologists have prescribing rights.

Yes, there is definitely a concern by psychiatrists that they can lose money. I don't believe there will be a glut of psychologists going for the training. Currently there are <1000 pharma trained medical psychologists (not all have been licensed). Obviously as more states pass legislation, the numbers will increase....but there is definitely a shortage of psychiatrists, so why not have a clinical psychologist who can see the pts weekly, have a strong clinical training AND get the proper pharma training (significantly more training in Pharma than med school, PA, etc)?

-t

[mercyteapot]

Originally Posted by Therapist4Chnge

...by getting more face time with their clinician, and not waiting 6-8 weeks for a 10-15 minute appointment? 15% of psych pts get their meds from a psychiatrist....not exactly an overwhelming majority of 'quality care'.



Yes, there is definitely a concern by psychiatrists that they can lose money. I don't believe there will be a glut of psychologists going for the training. Currently there are <1000 pharma trained medical psychologists (not all have been licensed). Obviously as more states pass legislation, the numbers will increase....but there is definitely a shortage of psychiatrists, so why not have a clinical psychologist who can see the pts weekly, have a strong clinical training AND get the proper pharma training (significantly more training in Pharma than med school, PA, etc)?

-t

Actually, ideally they'd get the face time and the meds visit. There's no psychiatrist shortage in San Diego.

[Therapist4Chnge]

Originally Posted by mercyteapot

Actually, ideally they'd get the face time and the meds visit. There's no psychiatrist shortage in San Diego.

One of the few places there are enough psychiatrists (SD, SF, NYC, etc) Go in the other 95% of the country...and there are shortages.

-t

[mercyteapot]

Why on earth would I want to do that?

[spaniel]

Oops was typing and lost my reply... Anyway, I got so very weary of the debate re RXP for psychologists. Since I'm licensed in both arenas, I had considered the NPP because it is so very slow going with the psychologist RxP priviledge. Lordy, I can remember "classes" starting for psychologists who wished to prescribe. These existed before online classes were even mainstream anywhere (I'm talking late l980's). Granted, a few states have the RxP for psychologists.
Yea, everybody blames it on the American Medical Association.I blame the schism of psychology itself. If psychology got it together and could "settle" on what a reasonable curriculum could be-then that would be great. I don't see that happening any time soon.
Generally speaking, the prescribing psychologist still need supervision by M.Ds-at least generally-that's what I've understood. The NPP does not need quite as much supervision in many instances. Please remember that the NP has about 6 years medical training. That is simply not so for clinical psychology. With that said, I do believe that any psychologist who gains the proper training could prescribe given certain parameters. I have worked in nursing since the '70's and also in psych. (My nursing experience includes umpteen years of critical care and I personally am comfortable with oodles of lab data,etc.)

[Therapist4Chnge]

Originally Posted by spaniel

.........Yea, everybody blames it on the American Medical Association.I blame the schism of psychology itself. If psychology got it together and could "settle" on what a reasonable curriculum could be-then that would be great. I don't see that happening any time soon.

That is one of my biggest gripes. We need to look at how other professionals came TOGETHER to get the legislation done (NPs, PAs, Chiros, etc).

Originally Posted by spaniel

Generally speaking, the prescribing psychologist still need supervision by M.Ds-at least generally-that's what I've understood. The NPP does not need quite as much supervision in many instances. Please remember that the NP has about 6 years medical training. That is simply not so for clinical psychology.

I know there are two methods right now...one uses a more limited list, and that is totally independent. The other (my preference) is a full list, with some collaboration. I think collaboration is important for any health professional, so this doesn't seem like a big deal.

-t