In the last month, a bill has been introduced to the California state assembly regarding prescription privileges for psychologists. Similar bills have already passed in New Mexico and Louisiana. Now, in case you didn't know, psychiatrists are medical doctors and have the ability to prescribe medications while psychologists do not. However, this bill would change that by allowing psychologists to gain prescription privileges (RxP) by undergoing a two-year post-doctoral education that involves both didactic instruction and practicum. The American Psychological Association is lobbying for this bill to pass under the auspices that psychologists can help meet the needs of underserved populations, particularly in rural areas. However, it seems that the true purpose is to gain a clear distinction for psychologists from other mental health workers - in other words RxP is for economic purposes. The bill is opposed by psychiatrists and some other members of the medical field.
I want to bring up a few key issues why I think it is a bad idea for California to allow psychologists to gain RxP.
1. There is little evidence to show that psychologists can provide quality medical care. 50% of all mental illnesses are associated with an underlying general medical condition. Psychologists may not be able to understand all of the nuances of these conditions to treat properly. The real problem is we do not know if psychologists will provide quality care, we should wait to see how it goes in New Mexico and Louisiana.
2. The reasons for pursuing RxP, particularly meeting the needs for clients in rural areas, may be a fallacy because it seems that most psychologists who pursue the further education will want to work in urban and suburban areas.
3. The training program may be too short to properly train. The APA is lobbying for a training plan but the plan is much different from the one that the Department of Defense used to train psychologists to prescribe. Again, it's a question of knowing whether or not it will work.
4. The occupation of the psychologist will work best if there is unity within the members. RxP will cause a disunity as psychologists choose to either pursue RxP or get left behind. As a field, psychologists need to stick together.
In the end I recognize that there are problems with the system we currently have. There are not enough psychiatrists and most prescribing is done by general practitioners who have little training in psychopharmacology (i.e. meds for mental health issues). This is a problem. But I don't think RxP is the solution at this time. Psychologists already have the ability to gain RxP through gaining an advanced nursing degree, which takes about three years, so proposing a separate avenue is premature at this point in time.
2 comments:
thanks curt. i agree with the broad points however, there are advantages to allowing people other than doctors to prescribe.
i lead on nurse-prescribing where i work and supervise a number of nurses who do a lot of the routine assessment and prescribing that frankly i find boring. they are more meticulous than I. as long as there is a doctor supervising i think it's OK.
however, i am a bit worried by psychologists doing it. i think there is a direct challenege to the psychology model and also i assume, being pribate US psychologists, they will be independant with no medical supervision.
in balance therefore, docs should probably be involved, but they havae to earn their right as the best prescribers, not just the ones who happend to have a license as that can be taken away!
Thanks Rob. It's nice to hear a psychiatrist's point of view. I believe that the plan is to make sure psychologists are working with the client's physicians but really there are few safeguards to ensure that in the proposed plan. I didn't get into the effects on the psychological model but those are certainly important too.
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