My Experience as a Prescribing Psychologist

It was a frigid February day in Grand Marais in 2006 when I received a flyer with a picture of Fort Lauderdale and the Nova Southeastern campus. The flyer was advertising a master’s degree in psychopharmacology created for doctoral level psychologists. It required the students come to  Fort Lauderdale for a 6-day weekend every other month, for two years. It must have been psychologists who thought of sending this flyer to me in Northern Minnesota in the dead of winter.

While the palm trees caught my attention, what kept my interest was gaining further training in psychopharmacology. Due to the remote location of my practice, it was difficult to get psychiatric care for my patients. Instead, I worked with the five local family doctors to obtain psychotropics for my patients. The doctors, by their own reports, did not have advanced training in mental health disorders nor in psychotropic medications. The idea behind obtaining this advanced training was to return back to my community and share the knowledge obtained.

I began the master’s program in the fall of 2006. The palm trees and beautiful campus were a wonderful draw, but the real excitement was the collaboration with peers and the vast amount of knowledge I was exposed to with the Nova staff. Our professors were chemists, biologists, pharmacists, physicians, psychologists and psychiatrists.

While the coursework was very dense, it was dynamic and manageable. Here is a partial list of the courses completed (for full list see

I. Basic Science

A. Anatomy & Physiology
B. Biochemistry

II. Neurosciences

A. Neuroanatomy
B. Neurophysiology
C. Neurochemistry

III. Physical Assessment and Laboratory Exams

IV. Clinical Medicine and Pathophysiology

A. Cardiac, renal, hepatic, neurologic, gastrointestinal, hematologic, dermatologic and endocrine systems.
B. Signs, symptoms and treatment of disease states with behavioral, cognitive and emotional manifestations or comorbidities
C. Differential Diagnosis

V. Clinical and Research Pharmacology and Psychopharmacology

A. Pharmacology
B. Clinical Pharmacology
C. Pharmacogenetics
D. Psychopharmacology
E. Developmental Psychopharmacology
F. Issues of diversity in pharmacological practice

I used to consider myself a better student of the “soft sciences” (like psychology and anthropology), but was amazed at how interesting and doable the hard sciences were; perhaps from being older and becoming more adept at studying and learning new material. It was also helpful to study in a group. All of us 25 or so students would meet to go over what we had learned and to prepare for exams while together in Florida. The students varied in age and specialty. We had many psychologists from the military who were sent there specifically for this training, to become a prescriber (since the DOD allows properly trained psychologists to prescribe). Other students either came from states that had prescribing laws and wanted to become licensed to prescribe or like me, were from areas that had very limited psychiatry.

For the practicum experience, I completed my trainings with two skilled doctors. One was a family physician whose practice had become almost completely psychiatric due to his skill in that area, and the other was a psychiatrist who worked mainly in the SPMI population. Both practica were incredibly fast paced and the information I gained I use to this day in my practice.

With this new knowledge in hand, my husband encouraged me to “go for it.” So I decided to sell my sea kayak, and move to New Mexico to pursue the conditional prescribing license. I obtained a position with the Indian Health Service in Taos. There I received outstanding supervision in a clinic setting. The physicians and staff psychiatrist were generous and informative. It was in this clinic that I completed my 80 hour physical assessment practicum as well as my 400 hour practicum and 100 patient presentations.

Next it was time to prepare for the PEP. The psychopharmacology examination for psychologists is infamous for being difficult. This is the national examination created by the APA and is subject to ongoing re-evaluation. The preparation time for this exam was one year, but individuals vary. The examination has few questions, but covers incredible breadth, so was challenging and more difficult in my experience than the EPPP. After passing the examination, and required additional training, I applied for my conditional prescribing license.

One interesting part of this process was the DEA license application. The DEA staff seemed somewhat surprised that a psychologist would apply, but once they looked up the new law, were helpful and prompt.

After receiving the conditional prescribing license and the DEA, I was  ready to prescribe within IHS. Because IHS is a federal program, if a provider is licensed to prescribe in either Louisiana or New Mexico, he/she can then prescribe within IHS anywhere in the county. The process of prescribing was very seamless and efficient. Within the 45 minute hour, we usually spent 15 minutes discussing medications and 30 minutes in therapeutic discussion. There were times when medications were not part of the patient’s treatment plan or when medication issues took up most of the session, but for the majority of patients, medications were a small part of the conversation (especially once they became stable on the medication).

Feedback from patients was very positive. They were glad to be with a prescriber who had the time to listen to concerns about side effects or any other concerns about medications. They were also pleased they did not have to schedule, wait, and go see another provider. They could get more mental health services accomplished in less time. For most of the patients there was no cost involved in being seen, but for those who had to use insurance, the cost was less for them.

In some cases I weaned people off many of their medications; especially benzodiazepines. There were certain patients who would be waiting outside the clinic before 8 a.m. on the day of their scheduled refills for benzos. They were “chomping at the bit.” Most of those patients had been started by a psychiatrist and they frequently stated they were not told the medication is addictive.

In the case of trauma and anxiety patients, it was often possible to wean them off medications altogether. Patients were able to reach their therapeutic goals with therapy alone. Frequently herbal supplements were integrated and sometimes replaced prescription medications.

Feedback from the physicians and my supervising psychiatrist was excellent and the advanced training surely helped me understand their medical treatment decisions. The rapport built during my time there continues to this day.

It was difficult to leave that practice and return home to Minnesota, but family was missed (and New Mexico has almost no lakes). It has been very useful to bring back the training and experience obtained in New Mexico and the psychopharm training was instrumental in my new job offer. Feedback from providers at my current position has been positive. The non-mental health prescribers (family doctors, pediatricians) state that they appreciate being able to consult with me regarding psychotropic medications. For my part, because the psychopharm training has been so useful, I work to remain current in the field of psychopharmacology and plan to for the rest of my career.

Mimi Y. Sa, Psy.D., L.P., MSCP (master of science in clinical psychopharmacology), conditional prescribing psychologist in New Mexico, currently works as a child and adolescent psychologist for Allina Health in Cambridge, Minnesota.  Dr. Sa is the chair of the Clinical Psychopharmacology & Collaborative Division of MPA.

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