Should psychologists be able to prescribe?

And should optometrists be able to do surgery? They already are permitted to prescribe based on requirements not very different from the proposal for psychologists. State optometric associations know that all that is really required for a class of professionals to be permitted to enlarge their scope of practice is to convince a state’s legislature to allow them to do so. After that, it is only a matter of finding local hospitals and surgery centers to grant operating privileges. Or in the right place, not even that, as long as they have the means to open their own surgery centers, which has absolutely nothing to do with whether they are actually qualified to operate.

CHenry

With the superior training psychologists have in psychopathology and psychotherapy, they are generally much better trained to treat psychological disorders these days. With additional training in psychopharmacology, I would much rather be treated by a psychologist than a psychiatrist (who recieves little specific psychological training these days) or a family physician who receives none at all—now they are frightening and underqulified.

As a trained psychologist, all I can think is, “Who are these idiot colleagues?” Even with a good training program in psychopharmacology, neuroscience, biology, etc., we are NOT medical doctors. I have worked with M.D.s for the adequate prescribing of clients, and these doctors are very open to discussion about the effects of psychotropics via psychological treatment. And I can’t believe that the APA, the most respected psychological association, supports giving psychologists PPs. This question is absurd.

I notice the psychology prescription movement is fueled by non-physicians stating they will take medical classes and complete an examination.

FACT: the examination is written by non-physicians to “qualify” non-physicians to prescribe.

What’s the old saying about wolves guarding the hen house?

The last “anonymous” completely missed my point about being on-call. I was making reference to the huge number of patient encounters that occur in the late hours of the night (psychiatry doesn’t keep bankers hours…but must psychologist choose to). I propose that more patient encounters equates to being a better diagnostician. I’m sorry I confused you.

i’m sure there was opposition when Nurse Practitioners became able to prescribe.
Oh my God, letting nurses prescribe!
I wonder how many people died and had adverse problems because of that.
I prefer my NP to most of the family practice MD’s i have had.
Give them a chance.

As a mechanical engineer this argument seems very familiar. I have friends that recieved their education in Industrial Design. For those that do not know, Industrial degree programs focus on the art of design, not the structure dynamics and/or its structual capability. The advantage of this program is you can work within the design industry without having to take all those hard classes, like a mechanical engineer does (heat transfer, mat’l science, fluids, calc I,II & III, linear algebra, differential eqn., FEA, and even chemistry). However most of the industrials that I meet want to have the seem abilities as a “real enineer”. Like most people in our world they want the privelages without having to work for them. Looking at curriculum overview for a clinical pyschologist, there is no way in hell they should be able to prescribe medication without supervision. What it boils down to is that they are pyschologists, not pyschiatrist for a reason: They didn’t have the ability or desiree to complete the arduous task of medical school.

As a senior in Psychology AND a Certified Pharmacy Technician, I think that I have seen plenty of wrong prescription writings by MDs and Nurses alike. I constantly see people given drugs such as ADDERALL, RITALIN, ALPRAZOLAM, DIAZEPAM, ESCITALOPRAM (Lexapro), and so on to patients who do not need them. It’s rather hilarious to read such one sided comments by MDs considering they have given C-II prescriptions to people who later sell them on the street for pure profit while Federal money pays for them (I would know, I have turned them in to be arrested). My opinion is that Psychologists should be the ones to psychologically evaluate the patient first, the doctor should prescribe, and then the patient has a chance of being helped. I believe that many psychologists wish to prescibe to merely make up for the incorrect diagnosis and prescribing by doctors and nurses alike. I’ve heard horror stories of nurses pulling out the DSM-IV TR and ask a patient a checklist, acting as if they were psychologists. Children under state custody, for example, will be taken to the local hospital and placed on several psychological drugs (antidepressants, antipsychotics, ADD/ADHD meds, etc.) without ANY evaluations. I notice that Bipolar disorder is said to affect under 1% of the population according to psychology; however, I know that I have filled plenty of Abilify & Lithium from PRIMARY CARE PHYSICIANS to make it around 15%! I feel that psychiatrists do not have the proper training to psychologically evaluate someone, but they do understand how drugs work. I feel that psychologists and psychiatrists must work together, but we all know it will never happen. I hope that Psychiatrists, MDs, and nurses take my advice and quit acting like psychologists. If you want to know why many wish to prescribe, it’s because you are making a mockery of the field of psychology and properly assessing individuals. You can’t give a pill (after 5 minutes of discussion), collect your check, and then go home while the patient may not have biological problems at all.

Peace, from a CPhT and psychology major who’s sick of this crap.

Someone asked about physician assistants and nurse practitioners. PAs have at least 2000 hours of (medical) patient care before they can prescribe and NPs have over 1200 when you factor in RN and NP school. A practice doctorate will be required for NP entry into practice by 2015. Both of these professionals have the type of patient care experience that allows them to recognize the difference between symptoms that present as medical or psychiatric mimics … and then act. A PhD in psychology plus pharm doesn’t teach that. The differential diagnosis for depression alone has tons of medical rule outs. How in the world is a provider supposed to be able to prescribe drugs that affect the whole body (and all psych meds affect the whole body) when they have no experience in diagnosis or the care of medical illness? Once you cross the line into medicine or advanced practice nursing, you have to be able to assess the whole patient. Studying how to assess and care for the whole patient and then spending years practicing this in school is how MDs NPs and PAs learn to prescribe. Even then, its hard enough to do it responsibly. A provider with prescriptive authority has to be able to order all the routine tests to follow up on monitoring protocols for those meds. Guess what? You also have to be able to determine what specialist your patient needs to see for prospective problems that the meds you prescribed may or may not have caused. That might include cardiology, neurology, gastroenterology, endocrinology, ophthalmology, nephrology or in some cases I’ve seen working in a psych hospital … emergency. There is so much more to treating a patient with medications than merely taking pharmacology. As a psychiatric nurse myself, I think that people who say otherwise are being naive.

Currently proposed rxp training requires 400 clinical hours (a whole 2 and a half months). NP’s have over 1200. PA’s have over 2000. MD’s have over 8000. But, a lack of medical patient care is only one issue. Perhaps the biggest issue is a lack of basic sciences. Every single other prescriber (physician or not) has similar prerequisites in basic sciences (biology, chemistry, microbio) etc. It is fantastic that psychologists take neurophysiology as that could help in their prescriptive practice. But, this does not take the place of chemistry 101. Without the benefit of basic sciences prior to beginning an rxp training, much of the 30 credits of the post doctoral training purposed by rxp advocates will be taken up with information that the students would have known had they otherwise taken basic science 101 classes. These are not required for psychology programs. Any attempt to skip or circumvent basic sciences seems really unsafe to me.

While family doctors may not know as much about mental health, they know enough to decide: 1.if the presentation is complex and needs referral to a mental health specialist before prescribing, 2. what medications to prescribe if the diagnosis is straight forward 3. the effects of the medication on the body, its interactions with other medications being taken, side effects and precautions to take.

Psychologists who prescribe are potentially dangerous because although they know about mental health, they don’t know about the BODY and can potentially harm someone eg a man on antihypertensives, warfarin, and a recent stroke who presents with depression – would you trust someone without medical training to give medication to him?