Idea: Prescription with PhysD

[Dentite]

Alright, I've seen this debate come up and the possible tension that may exist as psychiatrists see clinical psychologists gaining prescription rights.

Here is my idea. The current model for the PHd is the clinician-scientist model. However, the PsyD is gaining ground and is defined by its clinical orientation. If this is the case I propose that instead of just adding a few tack on courses in pharmacology for the clinical psychologist, that the PsyD be medical and therapy oriented right from the beginning of the program and would differ dramatically from the research oriented PhD.
The way it stands now, I don't see either the Phd or the MD psychiatrist being experts in both therapy and medication and this would provide an opportunity to do both.
Recruiting the right candidates wouldn't be difficult either. There are many psychology programs that offer an honour's science degree in conjunction with bio-chemistry departments.
The PsyD could be run as a separate professional school outside of the psychology department much the way dentistry, chiropractics, and optometry currently are. Of course considering how lucrative getting into this would be right out of undergrad, recruiters could select from among the top 1%. I think this also makes sense considering many MD's view psychiatry as a grey area of practice anyway.

Any thoughts on the idea and why or why not this would work would provoke interesting discussion.

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[ckent]

What's a PhysD? Do you mean a PsychD?

 

[Dentite]

Thanks for the correction. I had to edit my post. I meant PsyD.

 

[MacGyver]

There are already at least 4 pathways to prescribing medicine.

We dont need another one.

If you want to prescribe medicine, go to medical school.

If you want to prescribe medicines, you should have thought about that before you went the PhD-PsychD route.

 

[sasevan]

Hi Dentite,
I think that is a great idea. Just like many MD/DO who want to be primarily involved in research and teaching acquire a PhD the same could develop in psychology whereby clinicians could be PsyD and those involved in academia PhD.
Doctoral degrees like the MD or the PsyD have their origin as professional and not as academic degrees while the PhD began as the highest degree granted by a university. Again, I think your idea makes a lot of sense.
However, I don't think that psychology will go that way any time soon as most practitioners are at this time PhD. The future may bring about a different situation.
As far as your other idea regarding psychologists having prescriptive authority (RxP) I couldn't agree more, especially if from the very beginning of a PsyD program future clinicians were to be trained in both the behavioral and biological dimensions of mental disorders and the appropriate assessment and treatment
for these.
It has only been about 40 years since psychologists started doing psychotherapy; I believe we are now ready for the next step which is psychopharmacotherapy.
However, I know that psychiatry and medicine will oppose the expanded scope of practice for us. I don't believe that what happened in New Mexico will happen throughout the country. In Florida (where I'm at) nurse practitioners (NP) still don't have RxP for controlled substances like Ritalin or the Benzodiazepines eventhough they do in 44 of the States. So psychologists getting RxP here will probably not be the case in the next 20 years. As a result I'm now intending to go to med school to eventually become a psychiatrist (I'm a PsyD by the way).
Again, I really like your ideas.
Peace.

 

[Asher]

The difficulty with allowing professionals who have not completed medical school to prescribe psychiatric drugs is that they will not have had the training to recognize and understand the management of a patient's co-morbid conditions. While some depressed patients may not have any other medical conditions and can be safely started on a SSRI, many of the patients I have run across so far also have diabetes, hypertension, etc. I think that to prescribe a drug safely to these individuals one would need to do more than just run a check for interactions -- an understanding of the other disease processes and how they can complicate depression, etc, is important.

For example, a typical workup for many older patients with depression and possible dementia goes beyond just a clinical interview -- we would probably check a TSH, RPR, etc., and possiblely get some imaging studies. If psychologists are extended prescription privileges, will we also extend them the ability to order further tests?

I have been amazed at some of the psychologists I've worked with and the knowledge they have about psychological testing. The testing is something that they have had extensive training -- I don't feel like I would be competent to give and interpret these tools if some extra hours were added on to my residency training.

 

[Dentite]

Asher, I believe you make a very important point. I agree that overlap between disorders often has a somatic basis. I'm sure attending medical school also helps understand various contraindictions that might arise with medications (Ie. especially with the tricyclics of the past) However, I still think it would be possible to encompass everything into a single curriculum. For example, courses might include pharmacology, neurology, radiology, physiology, CBT, hypnosis, etc, etc. plus practicums. A 60 month intensive program should be sufficient to cover the basics I would think.
I havn't attended medical school nor do I have a psyD, but let's be honest. How much of what you learned in medical school can be applied to Psychiatry? There may be some overlap but does it really require 4 years?
I think a lot of it comes down to to egos and territory. If the ultimate goal is to serve the client then I think there are more efficient ways of doing so.

BTW, I just finished an honour's psychology degree. I'm probably going to do a prehealth plan and apply to medical/dental school. If the option I suggested was available though I would take that instead.

 

[MacGyver]

Originally posted by Dentite
If the ultimate goal is to serve the client then I think there are more efficient ways of doing so.

The New Mexico experiment basically proved that giving psychologists prescription rights does NOTHING to help the patient community.

Turns out that psychiatrists AND psychologists arent too fond of rural areas.

Urban patients already have plenty of options for healthcare--the only way script rights would help patients is in a rural setting.

 

[PsychNOS]

This is a topic argued ad nauseum. I've worked with and spoken to many clinical psychologists and the truth is that most of them would not feel comfortable prescribing medications even with a 60-month course.

Someone previously suggested that there is little overlap between general medicine and psychiatry. This reflects a total lack of understanding about both the fields of psychiatry and of medicine. Many people don't know that the board exam for psychiatry is 2/3 psychiatry and 1/3 neurology. You need a good knowledge of medicine in order to understand neurology.

The reality is that many psychotropic medications can unmask or cause medical problems (e.g., DM, QT prolongation, SIADH, EPS, etc.) It takes someone with an extensive medical background to be able to recognize and workup these complications.

The differential diagnosis for various psychiatric illnesses also requires an extensive knowledge of medicine. The differential diagnosis for depression, for example, would include metabolic and endocrine disorders.

Four years in medical school is not enough to make a psychiatrist. I takes an additional four years of residency. How would a 60-month course allow a clinical psychologist to perform the duties of a board-certified psychiatrist?

 

[Sanman]

Aside from whether they would want to or not, I'd imagine that insurance companies would probably gouge the malpractice rates for prescribing psychologists and it probably wouldn't be worth it for what could be a negligible increase in income.