An exciting Orlando convention

Psychopharmacology & Prescriptive Authority (RxP)

One of the most inspirational symposiums at this year’s Orlando convention was that chaired by Kevin McGuinness of the U.S. Public Health Service Regular Corps, who is a prescribing psychologist and president of Division 55, The American Society for the Advancement of Pharmacotherapy. “We had a very well attended symposium entitled ‘How to Become a Prescribing Psychologist.’ I had the honor of introducing the presentations by Bob McGrath (Fairleigh Dickinson University), Christina Vento (Southwest Institute for the Advancement of Psychotherapy/New Mexico State University and Virginia Waters, an RxP graduate of the Fairleigh Dickinson program. I outlined the APA’s recommendations regarding postdoctoral education and training programs in psychopharmacology for prescriptive authority and described the requirements for licensure in New Mexico and Louisiana. We included a discussion of grass roots advocacy, postdoctoral education, RxP licensure, social networking with psychologists, local political activism, affiliate health professions and the integration of psychologists’ roles in healthcare practice settings. Regarding the integration of psychologist roles, we emphasized faithfulness/consistency to the primary role as ‘clinical psychologist’; commitment to collaborative relationships with MDs, PCPs (primary care providers), and other psychologists; education of the public on the quality of comprehensive psychological service (‘one-stop-shopping’), and the need for prescribing psychologists and other psychologists to find their niche in primary care, rural medicine, academia, public policy and the APA governance.

“Bob McGrath discussed the responsibility of clinical psychologists to understand clinical psychopharmacology in order to serve in consultative roles across the spectrum of health care settings. He emphasized the role of post-doctoral training in clinical psychopharmacology to prepare such consultants and not only prescribers. Bob asserted his belief that clinical psychologists with such training have saved many lives. Virginia Waters discussed the value of her training at Bob’s program for preparing her as a consultant in a state that has not yet granted prescriptive authority to psychologists. She uses her training everyday in this capacity, especially when it comes to educating patients on the medications they are taking. Christina Vento, on the other hand, utilizes her training as a licensed prescriber. Both graduates functionally address polypharmacy by ‘unprescribing’ medications under appropriate circumstances and more fully utilizing psychotherapy as a primary therapeutic intervention. Our tasty ‘free lunch’ for those attending was undoubtedly a successful drawing card.” As our nation’s health care systems evolve towards integrated, patient-centered holistic care, it was very nice to see the next generation of psychology’s practitioners appreciating the inherent challenges and opportunities for their professional future.

Evolving journeys

Having retired from the U.S. Senate staff after 38+ years, I have become quite interested in how our colleagues are approaching this next phase (or journey) of their lives. Ruth Paige and Steve Ragusea: “All our lives we’ve been busy achieving and meeting responsibilities and expectations to — do well in school, raise children, earn a living, be socially and culturally engaged — and then, we finally retire. We haven’t been trained for this. And that makes it so urgent and scary for some…. But not others…. Some of us read the research on retirement long ago and began our preparations by slowing down and snorkeling. It’s not about stopping; it’s about slowing down and taking more side roads along the highway of life.” Summing up what seems to be a consistent theme for those who are successful in adapting to their new life, a colleague who recently stepped down from a high level academic position: “Pretty good – miss the people but not some other aspects. Am currently in North Carolina — was a bridesmaid in a wedding of friends from Hawai‘i — we were a mature wedding group — lots of fun. How are you doing?”

Academia

“How to terminate tenured professors? I am sure those of us who have reached or are reaching what has been the traditional age of retirement, age 65, contemplated retiring. While those of us in defined pension plans may have the incentive of realizing that their pension may be very close to what they are earning, and thus they may be working for close to nothing, those of us in battered 401K plans see continued employment as trying to regain their losses over the past several years. Moreover, the longer the latter group works the less money they will need because they will live fewer years in retirement; that is the real advantage to delaying retirement.

“Being tenured does offer a great deal of job security if you are not in a medical center. Terminating tenure for cause is a time consuming and drawn out procedure that administrators would prefer to avoid. Voluntary retirement is the preferred strategy. So how do you terminate a tenured professor? One cause of voluntary termination is social pressure and local norms. If the faculty member is in an environment that highly values research grants and publications then a professor who buys into those norms and is not performing might not feel good about continuing to work in such an environment. I have seen several faculty retire under those conditions who are still effective teachers as evidenced by the willingness of the university to hire them back to teach courses at less than 10 percent of their previous salary.

“An alternative to the above approach is to make the environment uncomfortable for the faculty member whose behavior is not governed by such norms. I have seen this happen to faculty but it is a very difficult strategy. Moving a faculty member’s office to an unpleasant location may have worked in the past but with the internet it doesn’t matter where you work. Assigning such a faculty member to lots of advisees or large classes is self-defeating for the university if the faculty member does a poor job. Moreover, anything that increases the alienation of the faculty member will result in even poorer performance and weaken the ability to influence the faculty member through norms or peer pressure.

“I have had a good life at Vanderbilt University. I have been here 31 years (not an expectation my family or I had when we came) and actively participated in the governance of the College and University as associate dean for research, chair of the IRB and chair of the most powerful committee on campus  — traffic and parking. I have also served two consecutive terms as chair of the faculty council. On the other hand I have been housed outside the department most of my time, first at a policy research center and then in the administration building. I have been director of a center since I came to Vanderbilt that has afforded me a great deal of autonomy. I would characterize myself more a cosmopolitan rather than a parochial professor in the classic Jencks and Riesman’s (1968) terms and thus local norms are less influential. Although I only taught two classes a year, after 40 years of teaching I wanted to focus on other things in my life.

“My wife partially retired several years ago but still serves as managing editor of a journal I edit. We have three children and four grandchildren, who we would like to see more often but teaching classes requires, at a minimum, that you show up in class. Some may see this as a minor inconvenience but with the traveling we wanted to do it is a significant barrier. Second, in the last decade we have developed a web-based measurement and feedback system that the university is commercializing, from which I will receive some income if it is successful. The system is based on several social psychological theories and has been shown to improve outcomes for youth receiving mental health services. But becoming an entrepreneur/ businessperson is a new challenge for me (and for the university since we are the first to do this inside the university structure) and takes a great deal of time and effort. Given these interests, I was ready to tradeoff my teaching for other activities but the university had to make it attractive to give up my lifetime guarantee of employment.

“At the end of June the university sent emails to all faculty members offering a new ‘Retirement Assistance Program’ for all tenured faculty in University Central that does not include the medical center. I opted for the ‘Transition Plan’ the university has offered. It was described as ‘a one-time window of opportunity will be provided to full-time tenured faculty members who have at least 15 years of continuous full-time service to Vanderbilt University and will be at least 63 years of age as of July 1, 2012.’ In addition, the faculty member will receive one year of limited health care coverage for each five years of service.

“I have been married 48 years and I always discuss decisions with my wife. However, I saw my dean about 15 minutes after I received the email and I told her that I would probably take the offer. She told me I was the second person to tell her that. I considered it a no-brainer. I was ready to give up my tenure, for a price, but not to retire. The dean and I agreed that I could stay on as an untenured research professor as long as I could support my staff and myself. With three or more years left on several grants, I thought this would work out just fine. This year I teach my last graduate and undergraduate class. The answer to the question posed in the title is simple — pay tenured professors to give up their tenure. I don’t know how the university came up with this plan but I would not be surprised if there were consulting companies that provided advice. I am curious to see which other professors take the offer and if it works out best for the university and the professors [Len Bickman].” Aloha.