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Hey folks, welcome back. We got a topic [00:01:00] today that I think is going to be very interesting and popular with this audience. I’ve got my guest, Dr. Rebecca Richey, talking about prescription privileges for psychologists.
Rebecca is a licensed clinical psychologist, a licensed clinical social worker, a certified addictions counselor, and will soon be one of Colorado’s first psychologist prescribers. She is the Clinical Director of Colorado Women’s Collaborative Healthcare, a Colorado nonprofit focused on providing neurodivergence testing to women, girls, and gender diverse folx.
So Rebecca, like you heard, is one of the first individuals to complete a post-graduate program in prescription privileges for psychologists. She is about to finish the program and she is here to talk about her experience going through that program.
So we dig into the background and what it means to have prescribing authority, different programs that are out there, main components of the program, cost logistics, [00:02:00] and how this might fit into her business model as a testing psychologist and psychologist providing other services to folks.
She also provides some resources to help guide anyone else who might be considering it. So if you have thought about going back to get your prescriber’s license or certification, this is a good episode for you. It is chock-full of information and pretty illuminating for anyone who’s considered going down this path.
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In the meantime, let’s talk about prescription authority with Dr. Rebecca Richey.
Rebecca, hey, welcome to the podcast.
Dr. Rebecca: Hey, thanks for having me, Jeremy. I’m so excited to be here.
Dr. Sharp: I’m excited for this conversation. This is a topic that is super interesting, at least to a lot of us here in Colorado, but it is gaining some steam nationwide as well. I’m glad that you’re here to give us a firsthand account of a psychologist going through this prescription privileges process. So thank you. We have lots to talk about.
I’ll ask the OG lead off question, which is why this is [00:04:00] important. Of all the things that you could spend your time and energy on, why add this to your life?
Dr. Rebecca: That’s a really good question. There’s two answers; one is very personal and one is more professional, but for both of them, it comes down to access.
As a practice owner and as somebody who’s worked clinically with clients for decades at this point in time, you always come to a place where the person decides it’s time for medication management and then it always feels like such a hurdle to find the right person and to find somebody whose values fit with this person, who has openings and who is accessible. And so that is why I decided to do it from a practice standpoint.
And from a personal standpoint, it feels like a social justice issue to me. So in a way that is very access based [00:05:00] that it’s hard for people to find medication management that feels like a good fit sometimes. I work with a specialty population and so I wanted to be able to be here for them and to have more tools to offer them to help with any sort of healing that we might offer.
Dr. Sharp: I’m with you. I hear this being pretty common across the country, but you’re in Denver, I’m an hour or so Northern Fort Collins. I know that we have the same problem; we cannot find psychiatric providers with openings and let alone that take insurance, let alone that take Medicaid, let alone all the factors as far as demographics or preference and style, and all those things. It feels like to ask those questions are a complete luxury at this point. We’re just looking for someone with openings.
Dr. Rebecca: Somebody who has the time. A big part of it, for me, is being able to offer the women, [00:06:00] girls, and gender diverse people that I work with, you already have a good rapport with them. You’re perhaps doing an assessment or working with them in some other capacities, and then like I said, this is just another tool in the toolbox that you can offer them that will help them get one step forward in their healing process.
Dr. Sharp: Right. There’s a lot to chat about here as far as logistics, practicalities and details. I think that’s probably what people are interested in. So let’s jump right into it. Let’s do a little background.
I might lead with the question of what are we actually talking about here? What does this mean to have prescribing authority for a psychologist?
Dr. Rebecca: It is such a good question and it differs state to state. There are 7 states that offer prescription privileges for psychologists right now. I’m not super familiar with all the other states, but in Colorado, what it means to have prescription privileges is a little bit more [00:07:00] limited than it sounds. And that’s probably just for right now.
What it means for right now is that we have the ability to collaborate with a client’s primary care provider, and in that collaboration, we can initiate a script for any number of psychopharmaceutical medications. We cannot do any sort of prescribing outside of that scope.
So even things that are off-label that are very common like propranolol for some anxiety related stuff, we cannot prescribe because we do not have the authority to prescribe propanolol. It’s a blood pressure medication first and foremost, that’s how it’s FDA approved.
So nothing off-label, nothing that is outside of those pretty strict bounds of psychopharmaceuticals, and we have to have written collaboration [00:08:00] from a client’s PCP in order to do that.
Dr. Sharp: I was going to ask a question about the collaboration. What does that mean exactly?
Dr. Rebecca: It’s still, in practice, getting ironed out on paper. What it says essentially is that you have to communicate with the client’s PCP. You have to have, like I said, written back and forth with them, that they’re giving not permission is not the word, but they’re giving their assent to have you prescribe this medication, and you also have to have that same collaboration if you are making any changes, whether that’s increasing or decreasing or discontinuing a medication or trying something else.
I’m not licensed just yet. It’ll be so soon, but that’s one of the things I assume will be a stumbling block in those first few months. I just telling you, I’m going to do a soft start first, [00:09:00] just so I can iron out some of these hurdles.
I think that was the biggest one is trying to figure out what exactly do I need the PCP to say? How and where do I need them to say that? Is it enough for them to email me or text me on my HIPAA-compliant platform to tell me this is okay, or do I need a letter? What does that look like?
Dr. Sharp: Interesting. I’m trying to discern what the purpose here is. It’s not supervision exactly because otherwise you could just consult with a psychiatrist, any medication prescriber. So there’s some element of, is it continuity of care plus a little supervision? What’s the rationale for having to communicate specifically with the PCP?
Dr. Rebecca: This is something that came about during the process of legislation. So [00:10:00] essentially, when the bill was written, this was not written into the bill, but this is something that some other states also use. They use it differently. From my understanding, ours is a little bit more stringent than some other states.
And the way that it came out was that this is what we’re going to do for now. We will sunset this legislation in 2029 and have an opportunity to all go back to the drawing board to think about how this works best. And so for the first 5 or so years, this is what was agreed upon in order to get the bill passed. I don’t think it would have passed without this.
I’m very close with Jen Lee and our CPA’s lobbyist, Jeannie Vanderberg, and they worked so hard on this. This is one of the things that came about during that process.
Dr. Sharp: That’s fair. So we [00:11:00] have this opportunity, but what does the opportunity look like? You have to get some extra education to be eligible for this whole thing. What does that look like?
Dr. Rebecca: You have to be a doctorate-level psychologist to even qualify for application into the program. So it’s called a postdoctoral master’s degree and it’s in clinical psychopharmacology.
When I was looking around, there were only five schools offered it. Now, I think there may be our eight or nine that are APA approved in the U.S. and I don’t know a lot about most of them, I know quite a bit about two of them though. So I can answer questions about those two.
I went to Fairleigh Dickinson which is in Teaneck, New Jersey, and I thought it was awesome. A great program. I thought it was hard. The program itself is 30 [00:12:00] class hours, which turns out to be 10 different classes that you have to take.
Both of the programs I know more about, so that’s the Fairleigh Dickinson program and then there’s a new program at University of Colorado, Denver, and so that’s very exciting. It just opened August of this year and everybody’s really excited about it. It’s going well so far. It’s also 30 credit hours for that program as well.
So everybody in both of these programs who are teaching, they know that we are full-time psychologists. Many of us have families. A lot of us are practice owners. And so they go out of their way to make it amenable to us to get through the process.
That doesn’t mean it’s easy. Actually, I found it very challenging. The classes were definitely different than what I’m used to in terms of graduate school programming, [00:13:00] but they’re willing to work with you and to make it something that you can get through. They know you’re busy, so they try to make it as flexible as possible so you can get what you need.
Dr. Sharp: Great. I’m looking forward to digging into the specifics of the program. I’m curious, though, you said when you were looking, there were maybe five out there. How did you choose that specific program?
Dr. Rebecca: I chose the program for three reasons. One was that at the time, there were only two that allowed you to do almost everything online. When I was looking, it was right as COVID was cresting. So in preparation for this, I was looking at some of the different programs.
It looks like most of them now offer mostly online. The hitch is that you have to have at least a week or some number of weeks of in-person training in order to do the clinical piece. So we have to learn nursing [00:14:00] basics. We have to learn how to do vitals and not like the cool machines that they have nowadays. We have to go old school and learn how to do the puffy blood pressure and all that good stuff which you can’t learn online.
Dr. Sharp: Right.
Dr. Rebecca: So I wanted a program that had something that felt reasonable in terms of in-person classes. And like I said, I’m close with Jen Lee and that’s the program she went to, and she really liked it. And so I was like, well, that’s full speed ahead. Let’s make it happen.
Dr. Sharp: Got you. What are we looking at in terms of cost, if you’re willing to share that, and how you manage the, I’m just thinking what would that even look like to go get another masters right now? I just paid off my student loans. I don’t want any more education. What’s the financial part look like?
Dr. Rebecca: It’s definitely doable for a full-time psychologist, for sure. I think in total mine was probably [00:15:00] between $25,000 and $28,000. It sounds like a lot, but it’s broken up pretty nicely in my program, and then also it’s very similar to the CU program where it was between $3,500 and $4000 per semester, and that’s for two classes.
And so there are 5 semesters that you take, and those are over two years. And so it’s that $4,000 every number of months, depending on how you plan it out. And then the in-person clinical that we just spoke about was another maybe $2,000ish.
It costs a lot because the CU program didn’t exist then but it costs probably $3,000 or $4,000 to fly out to New Jersey and to stay there. I think ours was maybe five or seven days. So that was a cost, [00:16:00] textbooks, those kinds of things.
So when it comes to dollars that you’ll have to pay out, those costs are, like I said, doable for most practicing psychologists over that two-and-a-half-year period of time. The hardest part is the practicum that’s been, we’ll talk more about that, but 20 hours a week out of my life for my practicum has been so difficult. I can’t even let myself think about the monetary bit that I’m sacrificing because I just can’t let myself go there. So it’s a lot.
Dr. Sharp: I get it. That might be a good segue to the actual program components and what you’ve done over the past two years. So what are the main big picture components of a program like this?
Dr. Rebecca: After digging into it, what I realized is that it is essentially like getting another [00:17:00] half of a doctorate. All the same things we did for our doctorates; you have to do for this program also. So that’s 30 hours of classes. That’s comprehensive exams. That’s a licensure exam and here in Colorado, 750 clinical hours of practicum.
Dr. Sharp: Okay.
Dr. Rebecca: So it’s a lot.
Dr. Sharp: That squeezed into 2 years?
Dr. Rebecca: Totally. A lot of the other people I talked to are on the same boat, but we have doctorates. We know how to succeed in class. The classes, like I said, the material was very different. I hadn’t taken a life sciences class for 25 years. Anatomy and physiology at the postgraduate level, that was rough for me.
Dr. Sharp: Of course. Give me an idea. What were the classes?
Dr. Rebecca: There are [00:18:00] four main topic areas here. There’s the sciences classes. So there’s neuroscience, anatomy and physiology, things like that. Neuroscience was a little bit easier for me just because through some of the other graduate work I had done, I had studied a lot of that stuff, but as I said, I had not done your heart, your lungs and your kidneys for over 25 years. And so I spent so much time drawing little pictures for myself and this bone’s connected to the other bone and all that good stuff.
So the sciences portion, that’s meant to bring you up to speed on the body and the chemical structures in your body and your brain. And then there’s a solid portion of the programming that’s meant to focus on ethics, which is very helpful because the ethics are very similar to what we as psychologists work with, but then there’s this whole new responsibility of medication management [00:19:00] and a lot of medication prescribers have very different ethics than psychologists do, but psychologist prescribers will not.
We have to keep our psychologist ethics, which means that we can’t prescribe to people that we know. We can’t have our neighbor come in and get medication management from us because that’s a conflict of interest for us, but for many physicians and nurse practitioners, that’s not a conflict of interest but will remain so for us.
Dr. Sharp: That raises a question for me in terms of where this practice is housed. Is this an APA oversight or is this a medical body oversight?
Dr. Rebecca: It is such a good question. The answer is that it depends on what state you’re in. So the APA oversees the programs themselves; the educational programs. They have a process for getting accredited through APA [00:20:00] but the practice itself, in Colorado, it’s overseen by the Board of Psychologists Examiners, which is the same thing that we have psychologists adhere to in our general practices.
In other states, it’s overseen by the medical board of state examiners. I think that there’s been some contingent about that. It depends, is the answer.
Dr. Sharp: Okay. That’s interesting. I don’t know that that would have been intuitive to me. It’s more of a medical practice, but I also get keeping everything under APA, that seems like that would get messy if all of a sudden our practice is split between two entities.
Dr. Rebecca: I think it gets very complicated in states, especially where the medical board oversees RxP the annotation for a prescribing psychologist. So in states where RxP is overseen by the medical [00:21:00] board. I think that’s part of the contention is that it gets a little messy maybe sometimes. I don’t know the details, but I do know that here the psychologist board of examiners oversees us.
Dr. Sharp: I got you. Back to the classes, you said there’s a big ethics portion.
Dr. Rebecca: Yeah. I really appreciated that because it’s hard to parse out, but then there’s the psychopharmacology classes as you would expect. There’s a series of those and the way that Fairleigh Dickinson did it is they split it up by issue like mental disorder that you might be working with. So there was one for psychotic disorders, a class for anxiety disorders, one for mood disorders, and then one for everything else.
My specialty is working with women, girls and gender diverse people in ADHD assessment and other neurodivergences, and so I was really interested in that everything else because we did a lot of ADHD stuff during that time.
[00:22:00] And then there’s some practice classes too. So just like we did in graduate school, there’s some classes on how do you weave together the psychopharmacology bit. And so we had some role plays and cool stuff like that to do.Dr. Sharp: Okay. Nice. And then from there, I guess we could talk about the practicum experience. Hold on, let me go back before we totally dive into the practicum because I think that’s a larger topic area.
With the classes, you said that they were manageable. I know it’s going to vary person to person, but do you have any idea how much time you were spending outside of class to prepare or study? Even on a scale of 1-10, how did this compare to graduate school forgetting your doctorate?
Dr. Rebecca: It’s a good question. We [00:23:00] had about two hours of in-person class per week, which is totally manageable to be honest.
Dr. Sharp: It seems easy.
Dr. Rebecca: Totally. It was the outside of class. And so no matter how much I studied outside of class, I always felt like I was missing something. It was predicated by the fact that I have a business and a family. I gave it all the time I could, but I always felt like I should have given it a little bit more time. I would say probably 4-6 hours a week outside of class on top of the 2 hours that we’re in class.
It felt manageable. I would do it after my kid went to bed. A lot of nights, I would take my reading with me to, if I got to get away to go to the gym, sometimes I would just peruse the material. I did a lot especially when studying for the licensure exam just because I’m a neurodivergent person myself and when my body’s moving, I can get hold of information a little bit [00:24:00] easier.
Dr. Sharp: Oh yeah.
Dr. Rebecca: I tucked it in where I could make it work, whereas with practicum, you can’t do that. You have to schedule those hours. It’s a little bit harder.
Dr. Sharp: Right. I would have to imagine that that experience of feeling like you’re missing something or could do more is pretty common. Do you know right offhand how many folks are doing this around another career versus just going straight to into it from graduate school?
Dr. Rebecca: 100% of the people in my cohort, 100% of us were in our 40s or late 30s and been doing this for some number of years. So this is definitely, we were all working. There was one student who I got close with. It was pretty remarkable. They worked for a government incarceration facility five tens and also did this. And so I was just [00:25:00] like, that’s amazing.
Dr. Sharp: It’s all relative, I guess, man.
Dr. Rebecca: The life-work balance is really not there when you’re in this program. I would just go ahead and say that. So go ahead and put that on the back burner for a little bit, and then you can come back to that when practicum is almost over.
Dr. Sharp: Let’s talk about the practicum and then I definitely want to come back to two things around work-life balance and also what I would perceive to be a pretty humbling experience of going back to school and being a learner again versus an expert. We can bookmark those, but I do want to hear about the practicum.
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All right, let’s get back to the podcast.
Dr. Rebecca: Let me tell you about the practicum. I do want to touch really briefly before we get there, though, on the two next steps that are in between our comps and then the…
Dr. Sharp: Oh yeah.
Dr. Rebecca: So at Fairleigh Dickinson, and I think every program does it differently, but the one that I went to, the comps were a three-hour open book test, I think it was 200 questions though in 3 hours. So it was quite stressful. And so [00:28:00] that was really tough.
In my graduate program, we had a written comps and also a practice comps. And so it was half of what I had to do for graduate school, so it was only like the written portion. It was a very stressful test.
It was nice that it was open book, but it barely mattered because there were so many questions you had to answer that it was like one a minute or even faster. Maybe it’s 200 questions, I forget, but I think I repressed that because it’s a little stressful. A lot of folks take them two or three times and that’s totally fine. They’re quite stressful.
I went ahead and took the comps last October. And so since I had already studied so hard for those, I went ahead and just scheduled my licensure exam for late January so that I could just continue studying from there and go right into the [00:29:00] licensure exam.
The licensure exam is called the prescribing exam for psychologists. It is a whole entire beast hands down. I would say in my personal experience, three times harder than EPPP.
Dr. Sharp: Oh my goodness. I was going to ask compared to the EPPP, three times harder.
Dr. Rebecca: But coming from a person who had zero life science experience, 1999 until whatever I took the exam.
Dr. Sharp: What made it so tough?
Dr. Rebecca: That was a huge part of it. They wanted you to know …
Dr. Sharp: It’s the biology.
Dr. Rebecca: Yeah. They wanted you to know how many nephrons per millimeter? I’m just making that up, but they wanted you to know the nitty-gritty and it was very foreign to me.
If [00:30:00] you’re somebody who has a biology degree or any of those kinds of things, then it’s probably going to be a lot easier for you. Also the neuroscience piece of it, of course, and I absolutely agree with this; they want you to know as much as a psychiatrist.
And so the way that the exam was explained to me was that we should study for this exam by studying for the psychiatry boards minus the neurology portion. What I understand is that psychiatrists in Colorado have to do a license for psychiatry and neurology. So they have to know a lot about like what are the five signs of a migraine and those kind of things.
I saw a lot of those questions when I was studying and tried to skip over those but we had to know all of the same information about neuroscience as was on the psychiatry boards. [00:31:00] So I studied for the psychiatry boards. There were two books that had practice tests in them. I took every practice test available for the psychiatry boards. It was a lot.
Dr. Sharp: That sounds intense.
Dr. Rebecca: It was exactly for me. It was very similar to the way the EPPP was. I would study all during the week. I made it a million note cards. I had color-coded everything. And then on the weekend, I would take a practice test and then cry a little, mourn a little bit then start Monday over.
Dr. Sharp: It’s relatable. Is it the same experience? Yes.
Dr. Rebecca: To me, very similar as the EPPP but with the EPPP, it’s stuff that I am passionate about, love and still use to this day; most of it. There’s 8 of 10 sections were things that I was super interested in. And [00:32:00] as a neurodivergent person, that felt really fun to just get that material but some of this stuff I was like, I’ve never heard these words in my life and so let me just figure out what this means real fast.
Dr. Sharp: Oh my gosh. It sounds super tough. I’m just thinking what would it be like to go back to that. It feels challenging. I know we’re going to talk about the time and how to fit this in and you’re almost done.
Dr. Rebecca: Totally. That was the biggest part was finding the time for those kind of things. And then we do come to the practicum and that’s been absolutely positively by far the hardest part that I’ve done so far for myriad reasons why it’s hard.
Even the way it started, it was so hard to find somebody who would supervise me. This law passed, the governor signed it in early March [00:33:00] 2023 and I started looking for a practicum in about May 2023 when I got the awesome opportunity to present to both the House and the Senate here in Colorado on behalf of RxP.
Once I realized how much momentum the bill had, I was surprised and in awe of Jen and Jeannie who really did this. And then I was like, oh, that means I have to have a practicum real soon. So let me ask everybody I’ve ever met.
So the way that this process worked for me, I worked at a large university system for a long time, and I discontinued that job to start my practice before the bill passed. I think in a lot of ways, it could have been a little smoother before the bill passed to get a [00:34:00] practicum because I think that people were like, whatever, it’s this cute little program that you’re doing, it doesn’t have any teeth.
So I worked in a fantastic amazing women’s specialty primary care clinic with eight physicians and for the most part were all like, yes, absolutely. I will support you. I will supervise you. This is no problem. My medical director is just an amazing human and went to bat for me so hard to the system, really tried her hardest to make it so that I could do my practicum at that amazing space, this women’s primary care.
After the bill passed, the system itself decided that there was going to be no RxP trainees until some big decisions were made. And so even up until this day, this is a year and a half later, [00:35:00] there are mostly no RxP trainees in this gigantic system, that is the academic system.
Dr. Sharp: Which eliminates a huge pool of potential training experiences or practicum, right?
Dr. Rebecca: Gigantic. We have to be supervised by an MD or a DO. And something that I observed and this is my personal experience while doing this is that family medicine doctors are so open to having psychologists around and not that other disciplines aren’t, but that family medicine doctors are uniquely excited to have colleagues in the mental health business.
And so many of them are under this gigantic umbrella, and so it really took the wind right out of my sails. I thought I [00:36:00] had a whole practicum placement that was somewhere that I loved; I loved the women I worked with, I loved the clientele and I was so excited, and then all of a sudden to be like, nope, you have to start from square one.
Dr. Sharp: That’s brutal. So you can’t go in this big system. So then you’re looking at private practices, small independent medical practices, what else?
Dr. Rebecca: I just hit the ground with my boots on and really started using every network I’ve ever made to try to find someone who would do this. I was honored and privileged to be a president of CPA six or seven years ago, and through that, had a lot of networking connections, both psychologists and physicians and started there.
I think I asked every psychologist I’ve ever met [00:37:00] in Colorado if they knew of any physicians who would be open to this, and Jeremy, thank you, your connection is one of the three rotations that I ended up at.
Dr. Sharp: I’m so glad that worked out.
Dr. Rebecca: Oh my gosh. It was an amazing experience, a truly amazing and honestly, life-altering experience for me to work with Dr. Craig Heacock. He’s out of this world. I was telling you a little bit earlier that I’m going to not completely shift, but part of my practice is going to shift into doing some psychedelic work and all that was due to the influence of Dr. Heacock. So he’s amazing.
Dr. Sharp: A former podcast guest. Great psychiatrist here.
Dr. Rebecca: Totally. Oh my gosh. It was so much fun to work with too. I’m not even exaggerating, I probably asked 100 psychologists if they knew [00:38:00] anybody. As a neurodivergent person, the rejection sensitivity that I had to just like …
Dr. Sharp: That sounds brutal.
Dr. Rebecca: Oh, gosh. And wade through, it felt brutal because once I had asked all of the psychologists that I know here locally, if they knew somebody, so many people were super helpful. They’re like ask this person.
So then I started to ask people that I didn’t know, but I was recommended by other behavioral health professionals. And so I would cold call them like, hey, here’s who I am. Here’s what I’m doing. Is there any room for a trainee?
The variety of responses I got back was just out of this world. And so some people were quite nice and saying, I’d love to help. I just don’t have time. My practice isn’t set up for a student. [00:39:00] I totally understand. As a practice owner, I get that.
I was very thankful for people who let me down that easy. Thank you for those humans out there, those kinds of things. And some people were brutal, just so rude because I was asking a lot of psychiatrists and other people who were doing this work, and it wasn’t psychiatrists specifically who were rude, but I got a lot of, like I said, brutal responses about how psychologists shouldn’t be prescribing and like, I won’t supervise anybody who hasn’t been to medical school. And if you wanted to do this, why wouldn’t you just go to medical school and just sort of like ouch.
Dr. Sharp: For sure. I could totally imagine that. I think that’d be really challenging. It’s a hard process [00:40:00] to put yourself out there like that. I can imagine there’s a lot of understandably protectiveness from the medical field. It’s probably like we feel about master’s folks doing testing or something like, is this legit? How can I trust you? And all that kind of stuff, but it’s really hard when you’re the person asking.
Dr. Rebecca: I think to my knowledge; I might be the first person who has got all my training in Colorado who will be licensed in Colorado. I think there are maybe five or six people licensed in Colorado who came through other states first. I think I’ll be the first person who’s done this start to finish here.
And so I was introducing a lot of people to the idea. They didn’t even know that psychologists can prescribe. And then they’re like, what, psychologists prescribing? I got the full fire of I think they’re processing through, that like this is a thing that’s happening now.
[00:41:00] Dr. Sharp: That’s such a good point.Dr. Rebecca: It was a small percentage of people, but I like that those responses just really stuck with me because it just felt really hard. And it felt hard to be somebody who’s been a behavioral health practitioner for 20 years and worked with so many physicians and had beautiful collaborative relationships and then just to have this really intense negativity, it just felt really gross, really yucky to me.
And you know what, the three that I ended up with were great fits. Those were not going to be a good fit for me and that’s fine. And so the three people who were willing to supervise me, I have learned a ton from. I’ve had awesome time going through and learning more about what their practices look like. I’ve been really thankful for their supervisions.
Dr. Sharp: It’s great to hear. I imagine there’s, like you said, a component to people just not being used to it, [00:42:00] and that means, well, and Amy did a program in another state, so it’s not like there’s a wide network of practicum experiences to pick from like probably most of us get in graduate school. They plug and play. We just go to the sites that have been established, but you were just blazing a totally new trail here in Colorado. And that just sounds like a complete uphill battle. It sounds really hard.
Dr. Rebecca: It was rough. I think for people who are thinking about it now, you will have a very different experience. I know Amy Wachholtz who’s incharge of the CU program that we discussed earlier, she’s actively working so hard to to forge these collaborative relationships and to open up these doors. There’s an RxP division of Colorado Psychological Association, and the head of that is working very hard also to create these collaborative relationships.
There are a lot of people doing a lot of work to get headway in these [00:43:00] areas and as more supervisors have experience with prescribing psychologists. And like I said, my entire cohort was people who have been practicing for years and so I can imagine that some supervisors, hopefully most, will have a psychologist student come in and they’ll be like, oh, you have all this knowledge or all this experience that we can collaborate together to make our patients or clients lives better. And so hopefully, if they have a good experience, then they’ll be willing to take on more psychologists also.
Dr. Sharp: Sure. So the finding the practicum was challenging to say the least. What about the experience itself? You mentioned the time commitment. Were there other challenging aspects?
Dr. Rebecca: Oh gosh, yes, absolutely. I think the time commitment is a huge part of it, but I didn’t expect to go through this, [00:44:00] but I had a weird moment where it felt really uncomfortable to be a beginner again.
Dr. Sharp: Oh yeah.
Dr. Rebecca: It’s not something I’ve struggled with my whole entire life, but like I said, I’m not young anymore. I guess young is relative, but I feel relatively old. How about that? I think also I’m not even an early career psychologist anymore, which is 10 years after you graduate. And so I think that in most areas of my life, I’m in a position where people are looking to me for the answers.
Dr. Sharp: Yes.
Dr. Rebecca: I feel like I know those answers, or if I don’t, I can connect people to the spaces where they need to go to get them. And I have a very specific niche and I am so passionate about this thing. I just snack on the details of it. Even in my free [00:45:00] time, I just want to know more about women’s ADHD, you know what I mean? So my depth and breadth of knowledge in this one space is significant.
I have to honestly, just start all over and I just kept having these experiences where I was like, why is this so hard for me? There was a time in working with Craig and he was the first, I started with him, which like I said, it was an incredible experience. His notes has a little two sentence summary where it says just what you would expect like this is what this person’s here for, this is what they’re diagnosed with, here’s the plan going forward.
And even that, I kept getting tripped up on. I kept getting so frustrated. Craig kept saying, no, Rebecca, just say it because psychologists are trained differently than psychiatrists. We’re trained to say, this person is [00:46:00] here, and because of A, B, C, D, and E, I believe their diagnosis is bipolar disorder or ADHD or whatever, and Craig was like, stop it, stop with the A, B, C, D, and E, just put that he’s here because he has bipolar disorder, and move on. It just felt so foreign to me.
He was very nice, very helpful and really was like, okay, this is a psychiatry versus psychology. He’s very psychologically minded to be cognizant and so I think he was able to be like, okay, let me just parse this out for you. This is how we can put them together. So it was helpful.
Every practicum I’ve been in so far, I’ve had moments where I’ve just been like, why can’t I get this? Why is this hard for me? And so it’s been very humbling, which we all have room to be humbled. So that’s fine but it’s [00:47:00] been a challenge also.
Dr. Sharp: Absolutely. We’ve talked a little bit about this off mic, but I think that would be incredibly challenging. I’ll be the first to admit, I really enjoy being seen for better for worse as an expert in many regards in many facets of my life. I think that to go back to this beginner’s mind or like a true learner, it would be so hard. It’s a vulnerable place to be so I have a lot of admiration for going through that process.
Dr. Rebecca: Thank you. To piggyback off of that, I think the three supervisors that I had, I know that they knew I had expertise in a very specific area but I struggled with how to show up with that expertise in their environment.
Dr. Sharp: Right. Do you come on really strong and overplay [00:48:00] it to make sure they know, or do you sit back and play it cool? Navigating all that sounds so hard.
Dr. Rebecca: Right. And so I was very lucky and got to work with a psychiatrist who has a very similar client population to mine. She was awesome and I didn’t want to interrupt. She was doing her thing and I didn’t want to jump in and be like, and there’s this, do we think about this part?
And again, it’s a difference between the models in a lot of ways that psychologists, and this is my own experience and this is me, I am long-winded and I want to say 15 reasons why I think this is what’s happening and examples of how it fits and all these things. It’s sometimes not how it happens in not a psychologist environment. You know what I mean?
So it was [00:49:00] hard to try on different how do you show up here for those things. I went through all of these things probably all practicum students go through like, am I disappointing my supervisor? Do they want to know more? Should I be saying more? Am I saying too much? Should I be backing off?
Dr. Sharp: I’m trying to paint the picture of the context here, you’re in the exam room, so to speak, with the physician and seeing the patient together. It sounds like there’s a lot of negotiation, either explicit or implicit around who takes the lead? When do I jump in? What do I say? Can I offer expertise or do I need to defer? It’s all those interpersonal dynamics that are hard, not intuitive necessarily unless you talk about it with the person.
Dr. Rebecca: That’s exactly right. I think Craig, like you [00:50:00] said, intuited that I was like, it’s not like I have something to say and started like halfway through the initial appointment, he’d be like, okay, Dr. Richey, do you have something that you want to say? I would say like, is it okay if I just go and we can continue from here. And so we got into a really beautiful rhythm where we were just bouncing off of each other.
Now, my longest practicum is in pediatric primary care. So it’s a whole entire different story, really different. And that’s been awesome also, an eye-opening experience in lots of different ways.
I realized at one point especially in not psychiatry, that it’s hard to understand how physicians are integrating the information that we give them from psychological testing and how [00:51:00] they’re using that information in the clinical room. And so part of what I’m doing, in most practicum that I’ve done, I’ve offered something in order to be there just because I’m blazing this path in some ways.
That’s what Jen Lee recommended. She had offered some integrative services at her practicum. So I’m doing some advanced screeners for ADHD and two other neurodivergences in the pediatrics clinic that I’m in.
In the first time that I started to work with the physician came out a kid who was definitely struggling with some ADHD stuff, took the report to the physician. It was just a little two-pager going over some stuff, gave it to her and she just peeked at it and was like, great, I see the diagnosis, let’s go talk to him.
And she said, before we went in, we’re going to have to talk to him about his sleeping [00:52:00] schedule, we want to make sure that he’s eating appropriately. I was like, oh, I already know all that because I did a screener with him. And she was like, oh, you know a lot about this kid and this family.
Dr. Sharp: Oh, interesting.
Dr. Rebecca: And so putting all that together is, like I said, been an eye opener. And also it’s been interesting to me to think about how much advantage we have as psychologists prescribing because we’re going to know these people like psychologists, like inside and out.
Dr. Sharp: Right. I could see it being a really nice adjunct to testing.
Dr. Rebecca: Absolutely. Just gorgeous in my opinion. As you know, you and I’ve talked before about the struggle with what to do with the RxP because in every program I know, but in my program, I heard several times, we’re not supposed to be junior [00:53:00] psychiatrists. That’s not our job. We’re supposed to be psychologists who do psychology, who have an extra tool in our toolbox to offer clients.
And that feels like a better fit to me than just lining up people to talk about medicines because I am passionate about what I do and I love what I do. And so having gone through all of this processing from about it and what’s this going to look like, that’s my plan is to continue doing assessment and then have a tool on the backend for women, girls and gender diverse people that I work with; do you want to do medication management here?
Dr. Sharp: Right.
Dr. Rebecca: I’ve already talked to your PCP. We’re already like this, why don’t I just call them up and see if they’re a go with this medication I have in mind for you?
Dr. Sharp: Yes. I wanted to definitely ask about how you’re going to integrate this [00:54:00] into your business. I have a lot of questions around that. I could see it flowing really nicely post-testing.
There’s a side question there that just popped into my mind about, I guess it’s an ethical question where if you’re doing the testing and recommend medication, what are the considerations so then just have to be mindful of knowing that you could prescribe and maybe you want to keep them, how do you navigate that? That’s maybe the first question.
Dr. Rebecca: It’s an excellent question. Because this is so new, I don’t think there’s a concrete answer. So I have elaborated with lots of people, some professors and other people who are prescribing already and asked some of these questions because whether you’re doing therapy or assessment, you’re going to have already worked with this [00:55:00] person and also then be offering them medication management unless you just switch your model and do that like primarily medication management.
I don’t think that’s what appeals to most psychologists who might go down this path. I think that it sounds and feels so much better to us to think of it as I’m going to keep doing the job I’m doing, which I love, and I’m going to be able to offer just something else on top of what I can already offer.
So in all of the collaboration I’ve done, just asking people who know more than I do about it, what I’ve gathered is that you have to have very clear and open informed consent about it describing that I can do your testing and after we’re completed testing, then we can talk about medication management, if that’s something you consent to, and also being very clear about it in the beginning about what that’s going to look like, what the nature of that relationship is going to [00:56:00] be, when it’s going to change, how it’s going to change. Having everybody onboard is the safest path for this, but I think there’s going to be a lot of ethical gray areas in those terms.
Dr. Sharp: That’s fair. I think there’s always some element of building the plane while it’s flying. We take our best guess with this legislation and the guidelines, but when you get into practice, you run into issues but I think some of us in some ways have navigated a similar situation. If we offer therapy or any other adjunctive service to testing, you have to cross that bridge of, okay, am I recommending this because I want the person to stick around and just do it with me or am I recommending it because it’s actually helpful and it’s going to benefit them. So hopefully not totally uncharted territory.
Dr. Rebecca: I think [00:57:00] the secret weapon there is having people who are smarter and have been doing this for longer than I have been doing it rely on, to say like how would you do this? Just getting a variety of input about what they would do and then I think that if a problem arises, then those are the pieces that are important to present that this came across this decision, those kind of things.
I’m going to keep Dr. Heacock as my supervisor even after. Yes. I’ve already set up meetings with him so that I’m going to be staffing most cases with him for medication management and I’ll do that until I feel 100%. So who knows when that’ll be, but I’m putting the pegs in place to have a safe practice.
Dr. Sharp: That’s great. Which brings up a super practical question, so these programs are meant to be all inclusive like when you’re done, you’re ready to roll. You’re [00:58:00] licensed, so to speak. There’s no like postdoc or post-program training that you have to do to be ready and fully licensed.
Dr. Rebecca: So kind of yes and no. Technically for the program that I’m in, you only have to do 400 hours of practicum, but since I’m in Colorado, it’s 750 hours. And so it depends on what state you’re in. And also some states, I believe, do you have, for the two years after you’re licensed, you do have to have a supervisor who can stick with you in addition to PCP. So I think it depends on what state that you’re in, but in Colorado, once you have your 750 hours, you’ve passed the PEP, you’ve graduated from your program, you’re good to go.
Dr. Sharp: Okay. Another very practical question, do you have any idea how this impacts liability insurance?
Dr. Rebecca: I expected it to be horrendous and to just work over piles of [00:59:00] cash. I’ve not crossed this bridge yet, but what I hear from others, it’s actually not that bad.
Dr. Sharp: Okay, that surprising.
Dr. Rebecca: I don’t know. One of the things I want to mention too, is that for practicums, a lot of the big systems that I asked if they wanted to supervise me, they will come back and say, we’re not sure because of liability and because of credentialing. Neither of those are actually a huge concern because you don’t need to be credentialed because you’re working underneath an MD or DO, just exactly like when we were students, we couldn’t be credentialed psychology students, but we worked under a credentialed and licensed psychologist.
And also the liability, so from what I hear, the liability and I don’t know, I have never done budgeting for a large system, but you know what I mean?
Dr. Sharp: It seems like of all the things to be concerned with, 5 hours a week from psychology student probably isn’t going to break the bank. [01:00:00] That is interesting though. That raises another question about how is this going to work with credentialing and if we wanted to bill insurance, is that going to fly? Are we going to have those CPT codes on our fee schedules?
Dr. Rebecca: We do. I hate to sound like a broken record, I do think it depends on what state you’re in. So I just saw old discussion about this. The Division 55 is a great resource if you’re somebody who wants to learn more about this. So this is APA’s, Division 55 is all RxP.
And there was a very healthy discussion on the listserv recently about the E and M codes, so for every psychology code that we use, there’s a sibling CPT code for E and M, which is, oh, gosh …
Dr. Sharp: Evaluation and management.
Dr. Rebecca: Yes. Thank you very much. And specifically, those are for medication management. And so I know that in at least two states, two of the seven, insurance companies are reimbursing psychologists for E and M codes. I know for at [01:01:00] least one other state, this is still a battle.
I don’t know what it looks like in Colorado yet. It’s on my list of things to do before licensure day to go spend two days with a prescribing psychologist because those are the questions that I still need, the logistical stuff is stuff I still need answered.
Dr. Sharp: Okay. Gosh, this has been so informative. I feel like we’ve covered a lot of ground in a short period of time. I really appreciate it.
Just to start to wrap up, people who might be interested in going down this path, are there any resources that you found helpful or even just reflecting back on your own experience, things to think about, things to consider?
Dr. Rebecca: Yes. I came up with a little 3 steps to knowing if you’re ready.
Dr. Sharp: I love a good 3-step process.
Dr. Rebecca: Let’s do it. And these have nothing to do with the programs or finances or anything. This is like, can [01:02:00] you do this? Every psychologist is academically prepared to do this. So don’t let that stand in your way.
The biggest thing that’s been hardest for me is the time. And so before you start to do the legwork to see if you can do this, I would absolutely positively recommend getting your supports in place and getting your supports underneath you; making sure that they’re there, that they understand what you’re doing, what that’s going to look like, what’s it going to feel like for them and what is that?
Like I have potentially the most amazing partner in the entire universe who was so supportive and knew that this year was going to be hard financially for us, and I was also probably going to be grumpy a significant portion of the time because I’m not going to put my business aside to do this. So I’m working sometimes 60, 70, even 80 hours a week, and [01:03:00] this is what it takes to get through it.
So without him, I could not have done this, 100%. I’m a mom. There were so many times where he took one for the team and was primary parent for longer than probably was comfortable. I can’t get her to school or take her home from school on days when I have practicum and so my dad stepped up to get her to school and back a lot of the time, which has been incredibly helpful.
I have three or four excellent friends who have been incredible at stepping up and taking her when I can’t. I have 8 hours study day today, I have to get through chapters five, six and seven. And so that you know, they took her to the circus and the museum. Having your community understand what you’re doing and [01:04:00] understand the support you’re going to need and having them say, yes, I’m going to be here for you is number one.
Dr. Sharp: That’s huge. I’m so glad you highlighted that.
Dr. Rebecca: Oh, I really couldn’t have done this without my community 100%. My daughter even asks me, she had to go to a camp that she absolutely hated the summer, poor thing, at YMCA camp. And she was like, “Mama, why am I doing this again?” And I would tell her, this is not forever. We’ll talk about next summer. So even she, without knowing it had to be on board.
Dr. Sharp: Right. That’s funny.
Dr. Rebecca: I think relative to that, I would definitely encourage you to go ahead and hire people that you think you’re going to need in your business. So I’m a practice owner too, and without the people who work in my business with me and for me, I absolutely could not have done this.
I don’t have time to do payroll. I simply don’t. And so I outsourced that. I don’t have time [01:05:00] to do all the paperwork kind of stuff, I got help with those things because I knew I didn’t have the time and patience to sit on the phone for an hour with an intern’s company or whatever, and so I outsource a lot. I thought of that. I knew it was going to be a financial burden to me, and it has been, but that’s okay. I think of it as self-care.
Dr. Sharp: Makes sense. You got to think ahead to what you’re going to need before you need it to create time for yourself and put systems in place.
Dr. Rebecca: The second step is having an idea of how you’re going to use this because I think I have wanted to quit more in the past 6 months than I ever wanted to quit during the actual academic portion of this. So having an idea of why you want to do this, how you want to do it and what that’s going to mean to you and to your practice going forward is imperative. So like anything else, having your why set out. If you don’t have the right [01:06:00] motivation, you might struggle more to keep your head above water.
Dr. Sharp: Yeah.
Dr. Rebecca: And then I think the third thing, having a plan for what you’ll do when you get to the point where you’re like, this is not worth it. I’m done with it and just setting it down. Who are you going to turn to? What supports do you need in place for that? Are you going to take two days off and disappear into the mountains? Will you sit in the hot springs for a day and then will you feel better after that? What do you do to keep you motivated and keep you going?
Dr. Sharp: This is good. I can tell you thought through this so much. This feels very deliberate. Maybe it didn’t feel that way along the way, but looking back, I think that’s so valuable just to be able to say, here’s what went well, here’s what people can do if they’re thinking about it.
Dr. Rebecca: And I really hope more testing psychologists do it. I think that giving my own experience that I [01:07:00] had the great fortune to meet so many amazing testing psychologists at your retreat last year. I think one thing that I noticed that we all have in common is that we all really love the data. We want to get our fingers into the numbers. The charts and the graphs are so yummy.
Dr. Sharp: Yes.
Dr. Rebecca: And I think that medication management is very much the same way. There’s a lot of data involved and a lot of like, here’s who this works for, and here’s who it doesn’t, and this is what this looks like. I think there’s a lot of science parts to it that I think testing psychologists will especially naturally think is a good fit.
Dr. Sharp: Yeah. That’s great. It seems like a natural connection. I’m excited about it. I haven’t dared to ask my wife if this would be feasible yet but [01:08:00] we’ll save that for a little while later. I hope that folks listen to this, maybe feel hopeful and start to go down this path, and if nothing else, coming back to what we talked about at the beginning, access is super important and this is definitely an area where we could use more access.
Dr. Rebecca: Truly. I think that’s part of what’s kept me going, it’s just thinking about every woman or girl or gender diverse person that I test and they come to, okay, I have ADHD, what do I do? And you’re going through that list of recommendations with them, here’s this one and here’s that one, and then you get to medication management and they’re like, how do I do that? And you’re like, yeah, how do you do this? Yes.
And so imagine 6 months from now being able to say, we talked about it before and if you’re open to it, then you can do that here.
Dr. Sharp: I love that. It’s a nice, hopeful, optimistic note to end on. Thank you so [01:09:00] much for coming on here, Rebecca. It was great to chat with you, we talk offline, but it’s cool to hear about your experience and share it with other folks.
Dr. Rebecca: Yeah. Thank you so much for having me. I’m always happy to talk about this. I’m happy to be a resource for anybody out there who has questions or just wants to chat, in between practicum and all that good stuff, we will find time, but let me know if anybody wants to reach out.
Dr. Sharp: That sounds great. I appreciate it.
Dr. Rebecca: Thank you, Jeremy.
Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.
If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.
And if you’re a practice owner or aspiring practice owner, I’d invite [01:10:00] you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.
The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational [01:11:00] purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric or medical advice, diagnosis or treatment.
Please note that no doctor-patient relationship is formed here and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.