Nurse practitioners sue California over restricted use of 'doctor'

I can see how people can confuse psychologists and psychiatrists. In behavioral hospitals, they're working side-by-side. Psychiatrists in that setting are more likely to perform psychotherapy than psychiatrists in other settings. Psychiatrists can perform psychological assessments; they just choose not to because writing prescriptions pays more, and they can refer patients to someone else.

The mental health field is a big mess with too many overlapping occupations, and some occupations choosing to focus on a small part of their field. You might think you can go to a clinical psychologist for therapy, but they'll tell you that they only do testing. A patient has to go find a counseling psychologist, clinical social worker, or counselor for therapy, but the counselor or social worker isn't qualified to do certain assessments. A psychiatrist's office will say they don't do assessments, and you need to come with a diagnosis. So, you have patients bouncing around for one mental health problem when a psychologist can handle two tasks, and a psychiatrist can handle three tasks.

 

Making sweeping generalizations and excluding medical doctors (MDs) in a statement about philosophies is misleading. In my experience working in critical care for over 30 years, I have encountered various trauma and disease processes, including the consequences of gun trauma. There can indeed be questionable treatment plans and potentially life-threatening actions from physicians. Still, it's crucial to remember that laws are in place to address such situations. These laws are not limited to floor nurses and have been implemented for over 15 years to simply IGNORE a physician's order. It is worth acknowledging that there is discrepancy between the public image portrayed by the American Medical Association (AMA) and the reality behind the scenes.

While I respectfully disengage from this discussion, I will continue to use my honorary doctoral degree title.

 

As a psychiatric Nurse Practitioner, I possess the authority to perform various tasks, including invoking a psychiatric hold for up to 28 days. This responsibility typically falls outside the scope of practice for professionals such as Clinical Psychologists, psychotherapists, counseling psychologists, clinical social workers, or counselors in most states. Additionally, I can provide treatment within an acute inpatient setting, a role that a Clinical Psychologist, who may hold a doctoral degree and call use Dr in their title and advertisement, is not typically authorized to perform.

Nurse practitioners often encounter situations where they need to analyze and assess previous treatment plans to stabilize a client effectively. It is not uncommon for Nurse Practitioners to prefer receiving referrals from other providers, including physicians. However, there may be exceptions to this practice.

The bottom line is that healthcare is a very small community. There are great providers and bad providers in every community. It doesn't matter what their title is or what you call them.

Hence forth I will only answer when called - ad cenam

 

LOL......

 

https://www.neiglobal.com/
No psychologist has ever completed there master psychopharmacology training
Many psych NP including myself, have....

 

The American Psychological Association has a review and approval process for educational programs in psychopharmacology in preparation for prescriptive authority. All are master's degree programs: Prescriptive authority program designation.

 

Here is an example of a program: https://www.fdu.edu/program/ms-clinical-psychopharmacology-post-doctoral/

Here is a personal story of a Psychologist who completed such a program: https://www.mnpsych.org/index.php?option=com_dailyplanetblog&view=entry&category=division%20news&id=135:my-experience-as-a-prescribing-psychologist

 

I don't know that this part is true, that psychiatrists can do psychological assessments "out of the box" without seeking out additional training outside of their residency.

For example if you look at Class C assessments by providers, they require doctorates in Psychology and do not specifically call out Psychiatry or MDs as being able to order them or being qualified to administer them: https://www.pearsonassessments.com/professional-assessments/ordering/how-to-order/qualifications/qualifications-policy.html
https://www.sigmaassessmentsystems.com/place-an-order/testing-qualification/

This article notes that psychiatrists lack the training to administer them, despite their occasionally doing so and the dangers that poses: https://journals.sagepub.com/doi/abs/10.1177/009318531103900308?journalCode=plxa

This thread on SDN quotes some psychiatrists as saying they don't or can't administer psychiatric tests because they either lack the training or the test itself states it can only be administered by a licensed psychologist: https://forums.studentdoctor.net/threads/psychiatry-and-psychological-tests.1019863/

I haven't found a solid reference that says psychiatrists can or cannot administer the tests, but I see plenty of references stating that only Psychologists can (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410123/ "Professional psychologists are the only mental and physical health professionals who have the legal right to use, administer, and interpret the psychological assessments")

 

You're just saying anything. I don't know what to make of these strange comments.

 

Psychiatrists administer the MMPI.
https://forums.studentdoctor.net/threads/do-any-psychiatrists-administer-interpret-mmpis.1468169/

In Texas, only psychologists and psychiatrists can administer psychological assessments to peace officers and correctional officers.
https://www.tcole.texas.gov/sites/default/files/FormsAppsPubs/licensee_psych_health_L3_0.pdf

Administering psychological assessments is a big part of forensic psychiatry. I had a professor who was a licensed psychiatrist and worked as a forensic psychiatrist. He administered psychological assessments.

https://link.springer.com/article/10.1007/s40596-017-0713-5

Psychologists do not receive training on every tool. They, too, need to receive training on an assessment tool they've never used before.

 

In 2022, there were over 200 prescribing psychologists in the U.S., which means they finished their required master's degree in psychopharmacology.

https://pubmed.ncbi.nlm.nih.gov/35511569/

The master's degree in psychopharmacology was created for psychologists, so why would many psychiatric nurse practitioners have this degree? Are you saying that many psychiatric nurse practitioners have two master's degrees, and they decided to earn a master's they don't need? These programs typically only admit those with a doctorate in psychology.

https://global.nmsu.edu/degree-programs/masters/clinical-psychopharmacology/index.html

https://www.isu.edu/pharmacy/mscp/

https://online.drake.edu/master-of-science-in-clinical-psychopharmacology/

 

I alluded to this in an earlier post. The DNP is not yet a first professional degree; it is a professional doctorate. I agree with your distinctions regarding content.

Some DNP programs are designed to prepare nurses to become NPs. But some are not. Some are designed for master's-level NPs to advance their education.

Nursing is going to have to clear up this stuff if it wasn't NPs to be taken more seriously.

 

Bene dictum! Praeclarum! (Nice one!)

 

https://nationalpost.com/news/world/its-not-an-ego-trip-should-nurses-with-phds-be-called-doctors

I found this interesting. I did not know that California is that restrictive:

"Several states regulate the use of the “doctor” title, but California’s law is the strictest in the country, said Donna Matias, the attorney representing Palmer and her co-plaintiffs. It restricts any person from using the word “doctor” or the prefix “Dr.” in signs or advertisements without having a valid certificate as a physician or surgeon."

“If you read the law literally, it appears to prohibit even PhDs and university professors from using the title,” Matias said."

"In practice, enforcement of the restriction to such a severe extent is rare, Matias said. But she said the crackdown on Erny, which stemmed from an anonymous complaint, set a chilling precedent."

 

I have had a certain amount of "inside" experience of the medical turf wars. MDs objected to DOs! Not just calling themselves "doctor" but being licensed to practice at all!

Speaking of osteopaths, our local osteopathic medical school, Burrell College, just "white coated" 200 new students. The need for more physicians is said to be acute. I have no reason to doubt that but I wonder whether the cause of the shortage in "rural areas" is economic.

We have the exact same problem with lawyers now. Our State Supreme Court is considering licensing "legal technicians" for independent practice in certain critical shortage areas like family law. Something over half of New Mexico counties have no resident lawyers.

What no one seems willing to address, though, is that East Tiny can't support a lawyer. The work might be there but the money to pay the lawyer enough to service a quarter million in student loans and make a decent living is not.

So we have an apparent paradox of having too many lawyers and new law graduates while seeing desperate shortages in much of the state.

We didn't have this problem when I got out. A JD from UNM was very nearly free. I took a low paid job in Eastern New Mexico because I could.

Just sayin'.

 

Incidentally I don't like the idea of legal technicians practicing independently in court. Such people can be very competent in specific areas of law before limited tribunals because you can't really get into trouble. The guard rails are there. Doing divorces isn't like that. Every possible area of law can show up in a divorce. To equip a legal technician for that sort of practice you'd need to send him to law school.

 

As one looking at DNP programs, I have no issue with a nurse being referred to as "Dr." in the proper context.

Use your doctorate to pretend to be a medical doctor? No way...

 

Well…how would that NOT be confusing to the patient?

 

The military trades training for service. They trade education for service. They trade experience for service. They trade pay and benefits for...wait for it...service.

The idea of a free (or nearly free) higher education has been demonized by politicians for decades now. Okay, maybe we don't need to pay for everyone to go to college to study anything. (Although we practically do that for K-12, with more specifics in terms of curricula.) But couldn't we target those areas most needed?

The military spends hundreds of thousands of dollars to graduate one officer from a service academy, even though studies have shown that those officers are no more effective than those from the other two (and extremely cheaper) commissioning sources: ROTC and OTS/OCS. Why can't we be okay to train lawyers who will trade that training for service in under-served areas for specific periods of time? Recruit students, loan them the money to go to law school (or wherever), and let them see their loans dismissed with service over time.

I'd like to catch a break like that. I've had 32 years of federal service, and zero relief from my student loans. I just don't qualify for anything. Nor did I get the GI Bill. But if such a deal was up front, I would have jumped on it and gone where they wanted me to go and done what they wanted me to do. Even the law.

 

I think proper context is stating up front you aren’t a medical doctor.