3 Future 1: Steady as she goes Declining opportunitiesDeclining say in health careTherapy “becomes” a master’s level practiceContinued lack of access to medication evaluationContinued over-use of medication and polypharmacyNJ ACO: Why would I hire a psychologist?Medicare coverage for IBT for obesity: no mention of psychologistsCMHCs: Declining participationSAMHSA-HRSA Center for Integrated Health Solutions: no mention of psychologists in integrated careNYS OMH: 700 psychologists declared “non-essential personnel”Non-academic medical centers have essentially eliminated psychologists
4 Future 2: Death by RxPPrescriptive authority expands; our economic viability is secured; potentially play a stronger role in health care designExamples exist alreadyIn the absence of a vibrant discussion about how best to prescribe, psychologists gradually surrender to economic pressures for 10-minute med checksTherapy “becomes” a master’s level practiceContinued over-use of medication and polypharmacy
5 Future 3: Rebirth by RxPPrescriptive authority expands; our economic viability is secured ; potentially play a stronger role in health care designExamples exist alreadyInstead of making believe RxP will go away, focus instead on creating a psychological model of prescribingTraining for conservative drug useTraining for combined therapyPractice guidelinesResearch on moderators of efficacyMedication as a transference objectRedefining the role of the prescriber in primary care settings
6 Insufficient Arguments Against Personal discomfort“I understand you don’t want to prescribe; do you mind if I do?” (Brian Bigelow)Economically naïveIncreased training for PCPsCollaborative decision-making with psychologistsCollaborative decision-making with psychiatristsContinue as we areInsulting: It’s just about moneyPolitically naïveFailure to pass = bad lawMichael Victoroff: “That donkey is overloaded already”
7 Is the Training Sufficient? National standard in Britain for non-physician prescribers is 208 didactic hours, 96 clinical hours (Br J Clin Pharmacology, 2012)Our standard: 450 didactic hours, 400 clinical hoursThe problem with pilot testingThe first RCT on APNs was published 35 years after training beganI have challenged people for years to identify a single topic essential to prescribing not covered in the training. I’m still waiting.All bills require some level of collaborationPsychologists have prescribed in the private sector for 10 years without any concerns raised, regardless of differences in training requirements
8 Medical Training as a Benchmark Medical training is wasteful unless you can demonstrate better outcomes/greater safetyPhysicians have objected to EVERY non-physician expansion of scope of practice on grounds of insufficient training. They have been wrong EVERY TIME.
9 Disciplinary Resistance Those raised against clinical psychology in the 1940sThis is just about moneyThis will change the nature of psychology“In many places there was indifference. And in most places active antagonism was the most characteristic response. … I have spoken of this attitude as the naïve division of the world into two categories: virgins and prostitutes. The experimentalists saw themselves safely within the first group” (Shakow, 1965, p. 356).Those raised against APNsTraining isn’t rigorous enoughIt’s not nursingTheir safety hasn’t been demonstratedTo some extent they were right. Training got better. When psychologists first became therapists, there were NO ESTs.
10 Celebrating our Colleagues Prescribers in all 3 military branches with health servicesPsychologists prescribed independently in both Afghanistan and IraqShearer et al. (2012): Survey of primary care staff about prescribing psychologists: over 90% found them safe and effectivePrescribing psychologists have been decorated by both the Army and the Surgeon GeneralA prescribing psychologist was deployed to southeast Asia after the 2004 tsunami and to Newtown CT after the Sandy Hook shootingAt NMSU, family practice residents receive their psychopharm training from prescribing psychologistsTwo of the leading authors in psychopharmacology (Julien and Stahl) have published books with prescribing psychologistsPrescribing psychologists have been exclusive providers of mental health services on several Indian reservationsDoes this sound fatally flawed to you?This does not include PDP graduates
11 ConclusionsPsychology IS a prescribing profession, and has been for 20 years with no evidence of problemsThe thesis of a fatal flaw is patently falseDeal with itRxP offers the potential for greater economic stability, improved access to evaluation, and reduced overuseWe would be better served if critics worked to improve RxP practice rather than make believe it will go away, because it won’t!Just because you don’t know any prescribing psychologists doesn’t mean they don’t exist.
12 Even if you are on the right track, you’ll get run over if you just sit there. -- Will Rogers
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