Article archive / March 1, 2011
Originally published: . Volume 2, No. 7. Source pages: 2, 15, 16.
After several years of serving on the board of the Academy of Medical Psychology and American Board of Medical Psychology the board has done me the honor to elect me President of the specialty board for the next two years. As I take that position we are reorganizing and automating the office and business functions to have faster and more efficient communication within the specialty and those students and interested doctors in the Academy who may or may not ever become board certified.
Board certification in medical psychology requires extensive training and demonstration of expertise. The specialist/diplomate in Medical Psychology must have extensive training at the post doctorate and post licensure level in the specialty. That training must go beyond simply becoming a Psychopharmacologist, but must follow the tenets of those designing Integrated Care for the nation where specialists in Medical Psychology will need to be able to diagnose and treat mental disorders with psychotherapy and medications (at a prescribing or consulting; LIII and LII functions) and be able to treat the psychological aspects of physical disorders (e.g. CHD, Obesity, Hypertension, Diabetes and especially juvenile onset diabetes, nicotine addiction and other addictions, and other disorders identified as negative cost drains on healthcare resources that have psychological and life- style components). Diplomates in the specialty of Medical Psychology have to pass a preceptorship, a national oral examination, and now a national written examination. Thus, the next generation of Medical Psychologist Diplomates is the best prepared psychologists to fill the large shows of placement in most Primary Care Centers and Medical/Surgical Hospitals under the emerging and efficacy validated Integrated Care Model.
This has not occurred without riff and the usual fractionation in psychology and the disciplines of healthcare in general. In the state of Louisiana there has been confusion about terminology and the term Medical Psychologist has been statutorily applied to what the rest of the world and many sub disciplines in national associations call “psychopharmacologists”. That is unfortunate, but happens in budding specialties that are formative, emerging, and evolving. A narrow vision of the specialty of Medical Psychology as a
Psychopharmacologist runs the risk of developing the devastating practice style (as evidenced by the decline of status of psychiatrists) of “seeing only or even largely patients for medication checks”. That would have a very debilitating effect on the psychologist’s ability to provide the needed functions in Integrated Care and would render us just another discipline that could be more economically replaced with a $60,000 per year nurse practitioner. The concept of our Academy and Specialty is much more appropriate for meeting the need of the emerging and evolving healthcare system.
We conceptualize the Specialist in Medical Psychology as much more than the pharmacologist (likened to Physician’s Assistants, Nurse Practitioners, and most Psychiatrists these days). Background in health psychology, clinical psychology, psychopharmacology, behaviorism, and prevention are essential to working in the Primary Care Centers of America. Psychopharmacology training and experience diagnosing mental disorders and selecting and/or prescribing medications within our specialty is also essential. We have analyzed the evolving healthcare models and systems and attempted to position psychology and the specialty in the best position to become an essential component of the Primary Care and Hospital Systems of America. We have concluded that the specialty of Medical Psychology fills such an important gap that exists in America’s Primary Care Systems that Diplomates in the specialty should be required in all Primary Care Centers and Hospitals in America. Therefore, we have joined organizations such as the national practitioner association for psychologists (www.nappp.org;http://www.truthindrugs.co m/) that have brought the public and professions increased knowledge about the scientific evidence of the significant limits of “medication only approaches” (really the only approach offered by most Primary Care Centers and Hospitals in America). We have developed clear standards which clarify the very different skill levels of psychopharmacologists (whether in psychiatry, psychology, advanced practice
nursing, etc.) and specialists in Medical Psychology.
In the state of Louisiana we are likely to lose about 15 of the slightly over 30 Diplomates in Medical Psychology because there is resistance to facing the broader vision of the specialty and a natural resentment because, in the state, the evolving specialty confabulated the concepts of psychopharmacologist and medical psychology. Further, a break with the traditions established by many of us who helped write and lobby state licensing laws occurred in Louisiana when psychologists set up a psychopharmacology law that is supervised by the board of another discipline. Thus, to continue their psychology specialty as one of our Diplomates Louisiana psychopharmacologists would have to maintain their license under the psychology licensing board and also maintain their other license under the Medical Board sub board. This places a financial and philosophical hardship on some of our diplomats and creates a natural resentment because of the unique licensing laws formulated in the state. Many of our Diplomates have written us and are happy to maintain both licenses and will retain their specialty board certification in Medical Psychology, others will act out their preference, right, and/or resentment about the situation by blaming a projection entity and losing their qualification for retaining their specialty board certification. The whole frame is unnecessary, unfortunate, and was not thought through well in conception. It is fraught with the dangers long conceptualized and avoided in psychology licensure efforts of “avoiding regulation under the power dynamics of another profession”. Still, our board will maintain high standards, our fidelity to the traditions of psychology licensure as a base for our specialty training, and our independence from other
professions. We love and respect our Louisiana Diplomates (the ones that continue their specialty board certification, and the ones that feel compelled to lose this status) and empathize with the bind that they have found themselves.
On a happier note, our specialty is delighted to have many active prescribing (LIII psychopharmacology) members from the Military, New Mexico, and Louisiana, and we realize that ultimately our specialty will be dominated by consulting psychopharmacology practice (LII). Both, in our opinion, carry a very important burden and function in the new and evolving healthcare system and in the Medical Psychology Specialty. Clearly, our LII diplomats will become increasingly in demand in Primary Care setting where general physicians will have to continue to prescribe as much as 70% of the psychoactive medications and will need accurate psychological diagnoses and multi-intervention treatment plans. The Medical Psychologist is the essential missing part that will equip the Primary Care Center and local Hospital to match medications with the appropriate diagnosis and to use change oriented psychotherapy in combination with symptom controlling medications. There has never been a better and more encouraging time for our specialty. Many of our physician colleagues and friends will be able to salvage their reputations that have been dampened by the public’s growing
awareness of the significant and scientifically chronicled limits of medication approaches by demonstrating solid collaboration with psychologists who are colleagues and housed within their centers. Wise physicians will embrace the science, add psychologists to their practices, and lay claim to the mantel of scientific, healthcare leader, and teamwork oriented.
I am encouraged by the future of our specialty of Medical Psychology and am very proud of our Louisiana Diplomates. I am also encouraged by the many who are not intending to qualify for board certification but have joined the Academy of Medical Psychology because of their interest in the expanding area and related study and society affiliation. I am very proud of our LII consulting psychopharmacologists and Board Certified Medical Psychologists who are changing the image and contributions of psychologists in the Primary Care Centers and Hospitals across the country. The general physicians I’ve talked to across the country are developing a new appreciation for how mental illness and the psychological aspects of physical illness are much more complex than basic biology and pharmacology and for the contribution that psychologists can make to their practices and patients.
He is a Board Certified Medical Psychologist. (Dr. Morris is licensed in Louisiana. He serves as the director of behavioral health for four primary care centers and a hospital complex affiliated with his psychologist owned comprehensive community mental health center, where he may be contacted at jmorris@bcmhospital.com.)
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.