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Newsgroups: bit.listserv.psycgrad
Date:         Fri, 4 Sep 1992 17:00:49 PDT
              <PSYCGRAD@UOTTAWA.BITNET>
From:         Rick Adams <adamsr@NETCOM.COM>
Subject: Re: Psych-iatry vs -ology?

Tim,

	You (and the others involved in this discussion) raise some
interesting issues. For what it's worth, here are my views on the issue.

	Clinical psychologists NEED the ability to prescribe medications.
Perhaps in a medical setting such an ability isn't necessary, certainly if
you have a psychiatrist down the hall it's a simple matter to request a
consult. But not all - or even most - psychologists PRACTICE in such
settings.

	In a non-institutional setting, not only does such a consult become
difficult, if not impossible, to obtain but the resultant cost to the client
becomes a legitimate issue. For a client who has good insurance, it isn't a
problem, for the client who is paying a $5/session token payment based on
income, it becomes a serious one.

	More important, however, is the question of your relationship to
your client. If that person must go to a psychiatrist for medications, it
raises serious questions in their mind as to your own capability to help
them. Again, in a medical setting this isn' relevent, in private practice it
is.

	Finally, there is the very real concern as to who will manage the
treatment strategy. Presumably, as a clinician, you will have a perspective
from which you believe the client's treatment must be approached. Under such
circumstances, a referal for medications will probably be a part of an
overall treatment strategy aimed at affecting change for your client. WHat
happens if the consulting psychiatrist holds a very different view as to the
appropriate treatment (i.e., assumes a medical model versus your own
cognitive or analytic one) and the resultant choice of medications
negatively influences your treatment strategy? This is far from a theorical
question - it happens FREQUENTLY in private practice.

	Of course you *could* make your referal to a GP rather than a
psychiatrist, since it is less likely that a GP would contravene with your
treatment strategy. But then you run the risk of inappropriate medications
(and dealing with Tardive Dyskenesia [sp?]) due to inexperience on the part
of the GP. Still no solution. Of course, if you are experienced enough to be
able to tell the physician precisely what to prescribe and what dosage, you
will eliminate that problem - but in that case why shouldn't you have the
ability to prescribe the medications yourself?

	Clearly it is easier for a psychologist to be provided the
additional training to insure save management of psychoactive treatment
regimes than for that person to become a MD/Ph.D.  Not only do most
clinical programs include many of the requsite courses anyway, but the
additional ones would serve to make the person a better practitioner anyway.
Given that most practitioners will never become involved in experimental
psychology anyway, the elimination of a few course requirements in research
areas and their replacement with medically relevent courses would create a
new, and very useful, program in applied clinical psychology.

	Ideally, the following structure would be appropriate:

	Ph.D. - A research degree WITH clinical training and requiring an
additional year of medical studies to obtain licensure to prescribe
medications. Would include all present research and experimental
requirements.

	Psy.D. - An applied degree in clinical work with the requsite
medical courses integral to the program. Less emphasis on the research areas
than in the Ph.D programs (as now) and more emphasis on client treatment.
Would include all courses required for licensure to prescribe medications.

	Both degrees would be required to meet standard guidelines as they
are now for licensure - in addition, the school offering prescription
licensure would be required to be either APA or AMA approved (courses for
currently licensed clinicians would be available in a one year full time two
to three year part time program). Continuing credits would be required to
maintain licensure. Those with degrees below the doctoral level or without
requsite training would not be eligible for licensure to prescribe. An MA
psychologist would still be eligible for limited licensure (but not for
prescription licensure) as they are now.

	These would seem reasonable approaches to the question. In addition
to the other benefits of this form of licensure, such privileges would
ultimately lead to admitting privileges as well - something that would both
enhance the prestiege (and salary range) of our profession, but would permit
the clinician to better serve their client as well.

	Right now there are neuropsychologists in practices with
considerably more knowledge of human neurobiology and drug interactions than
most psychiatrists will ever have (or want). To deny these individuals the
ability to prescribe psychoactive medications while permitting GPs to do so
is absurd!

--
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