Transcript Presentation

CDR Samuel Dutton, Ph.D., M.P.
2012 COA Symposium
College Park, MD
Working the Steps….
 1. Choose a state (LA or NM)
 2. Choose a degree program
 3. Apply for psychology licensure
 4. Plan for the PEP
 5. Complete your degree program
 6. Take and pass the PEP
 7. Apply for RxP state licensure
 8. Apply for CDS number (DEA & state)
 9. Seek prescription privileges at your facility
 10. Obtain a supervisor for your initial prescribing
 11. Obtain independent privileges to prescribe
 12. Continuing medical and psychopharm education
1. Choose a state
 LA – Must obtain “concurrence” on all scripts from
patient’s primary care provider. Does not require a
period of supervised practice.
 NM – Receive a conditional prescribing certificate,
then have to prescribe under the supervision of a
licensed physician for 2 years.
1. Choose a state
What do you need in LA?:
 A Master of Science in Clinical Psychopharmacology
degree
 A passing score on the PEP (you have 3 tries)
 A license to practice psychology in Louisiana
 You apply to the Louisiana Board of Medical
Examiners
 72 Medical Psychologists in Louisiana now
1. Choose a state
What do you need in NM?:
 A Master of Science in Clinical Psychopharmacology
degree from New Mexico State U./Southwestern Institute
 NM may make an exception if you fly to NM for their hands-
on Physical Assm’t course (1 weekend/month x 6 months)
 80-hour practicum in clinical assessment (two weeks straight,
primary care medicine)
 400-patient-hour physician-supervised practicum treating at
least 100 patients with mental disorders
 A passing score on the PEP
 A license to practice psychology in New Mexico
 You apply to a joint NM board of psychology and medicine
 30 prescribing psychologists in NM now (12 are
conditional)
2. Choose a degree program
There are only 4 that award you the accredited
postdoctoral degree:
 Alliant University – first and oldest, biggest,
completely distance learning
 Fairleigh Dickensen Univ. – based in New Jersey,
almost all distance learning
 Nova Southeastern Univ. – Florida, must attend classes
in person (1x/month)
 Southwestern Institute/NM State Univ. – NM’s
program, must attend in person
PEP Performance: Postdoctoral Psychopharmacology Training
Programs 2000-2007, APA Practice Organization, 2007.
PEP Passing score: 106 (70%)
% Who
n
Mean
SD Average Fail Pass
NOVA Southeastern U.
12
112.3
6.1
75%
15% 85% 
Mass Schl of Prof Psyc
11
109.1
7.9
73%
35% 65%
Prescribing Psy Register 13
111.2 14.0
74%
35% 65%
Alliant Int'l Univ
74
110.1 13.9
73%
38% 62% 
NM State Univ
10
107.1 11.2
71%
46% 54% 
Fairleigh Dickinson U.
49
105.5 15.4
70%
51% 49% 
Georgia State U.
16
101.9 14.2
68%
61% 39%
Illinois Schl of Prof Psyc
5
100.2
5.7
67%
84% 16%
Total 190 107.9 13.1
72%
44% 56%
3. Apply for standard psychology
licensure in NM or LA
 Start one or two years early so this doesn’t become a
rate-limiting step, especially if you don’t have the
Certificate of Professional Qualification (CPQ from
ASPPB).
 Both LA and NM accept the CPQ, NM also accepts
Nat’l Register. NM has no oral exam, but using CPQ in
LA allows you to bypass LA’s oral exam (even though
you still have to meet with the Board).
4. Plan for the PEP
 What you learn in your degree program isn’t entirely
what you need to know.
 Focus on the actual practice of RxP, get as familiar as
you can with the drugs, their side effects, mechanisms
of action, lab values, common medical conditions, etc.
 If at all possible, work with the drugs, e.g. with a family
practitioner who sees patients who need psychotropic
meds.
 You will not have time to review everything before the
PEP, so REVIEW AS YOU GO ALONG.
5. Complete your degree program
 Ideal scenario: 1 day per week = 8 hours study time
 Used commute time
 Burned leave when really necessary
 Advantages of not attending lectures real time
6. Pass the PEP
Commit to taking it within 6 months of graduating:
 Once APA’s Practice Organization approves your
application to take the PEP you have a 3-month
window to take it.
 There is a practice PEP of 75 questions; use this as a
gauge as soon as you graduate (Professional
Examination Services via TestTrac.com website).
 If you fail the PEP, you need to devote serious time to
your next attempt - more time per week than you did
for your degree courses.
7. Apply for RxP licensure
Once you pass the PEP, you apply for your RxP license.
 In LA, this is straightforward and quick.
 In NM this is involved, you must have also completed:
 the 80-hour clinical medicine practicum
 400-patient-hour psychotropic medication practicum
 Documentation burden is significant
8. Apply for CDS number (DEA &
state)
 Controlled and Dangerous Substances (Schedules II-
V) – you need to obtain a Drug Enforcement Agency
number to prescribe these drugs. It’s a $500 fee for 2
years, but if you are working in a federal agency, you
may apply for a “fee-waived” DEA number.
 State pharmacy boards also have a CDS number, you
need to get this before you apply for your federal DEA
number.
9. Seek prescription privileges at
your facility (= get credentialed)
 Suggestion # 1: Usually the fewer psychiatrists at your
facility, the better. Zero might be a good number. Closer to
residency is more friendly than senior. Military is more
friendly than civilian.
 Suggestion # 2: The smaller the agency that credentials
you, the better. E.g., a 100-staff clinic is better than a 1,000staff medical center.
 Suggestion # 3: The more credibility and support you have
from family practice physicians, the better.
 So far, only the military and IHS have credentialed RxP’rs
(and 1 community clinic in Las Cruces, NM). The military
has officially endorsed RxP in all 3 services, but several
RxP’rs have been shot down at the military treatment
facility level, especially in the Army.
10. Obtain a supervisor for your
initial prescribing
 This will be mandatory in the military for independent
credentialing. Military regs require the supervisor to
be either a psychiatrist or a prescribing psychologist.
 For NM licensure this is mandatory. Supervisor must
be “a licensed physician knowledgeable of the
administration of psychotropic medication”.
 If you practice in LA, no supervisor is required, just
primary care provider concurrence (until MPAP).
11. Obtain independent privileges
to prescribe
 Navy: must see 100 patients (not just 100 encounters),
this mirrors APA’s recommended RxP training model.
 Air Force: must be supervised for 1 year.
 Army: must be supervised for 1 year, and it must start
within 24 months of passing the PEP.
 IHS: So far, everyone in IHS has gone through NM,
and two years of supervision is required under NM’s
conditional prescribing certificate.
12. Continuing medical and
psychopharm education
 Louisiana Medical Board requires about twice as many
annual CEU’s to maintain your MP license as does the
Psychology Board to maintain your psychology license
 Stephen Stahl’s Neuroscience Education Institute
 Daniel Carlat’s Psychiatry Report
 Louisiana Academy of Medical Psychologists (4x/year)
 Be aware of Big Pharma
 There is always more to know….but it is interesting!
Questions?...
 Feb 18, 2005 – John Bolter, PhD, MP, becomes the first
state-licensed psychologist to prescribe medication.