Associated Press – April 18, 2005 – BATON ROUGE, La. – The first of the so-called “medical psychologists” began signing prescription pads more than a month ago with little fanfare, among the first psychologists in the nation to prescribe drugs. Louisiana and New Mexico are the only states that allow psychologists who complete specialized training and pass a national exam to write prescriptions for medication. Both states began issuing the prescribing certifications and licenses to a handful of psychologists within days of each other in February. Backers of Louisiana’s new law said it would provide better coordination of patient care, reduce patient
costs and offer greater access to mental health services for people who would otherwise have long waits to see a psychiatrist. “It’s not hard to refer them. I can make a referral, but it would take three months,” said John Bolter, a Baton Rouge psychologist who wrote his first prescription in February after years of front-line work to get that expanded authority. Louisiana, like New Mexico, requires psychologists who write prescriptions to consult with physicians, but critics – including psychiatrists, who must have medical degrees – said both training and supervision are inadequate under the new program and jeopardize the lives of patients. Jason Young, with the American Psychiatric Association, said if the psychologists pushing for Louisiana’s law worried about getting care to underserved areas, the law would have contained incentives for practicing in rural areas with less access to mental health care. “There were no Louisiana citizens clamoring for this law in the first place,” Young said. “This was designed by psychologists.” The issue isn’t limited to two states. Thirty-two others have psychological associations looking into prescriptive authority, according to the American Psychological Association, and legislation was introduced in seven states this year.
The issue of adequacy of training, especially with respect to drug interactions (not only with other prescribed medications but also with non-prescription drugs such as over-the-counter remedies, herbal remedies, and even dietary supplements) and with known personal and family medical history, is one that as a psychologist concerns me greatly. There are times when I have doubts about the adequacy of training in some of my colleagues even to correctly interpret standardized psychological tests and frankly that doesn’t increase my confidence in the ability of psychology departments to provide what I would consider to be a safe standard for training in pharmacology and medicine. And I do not believe that training in psychopharmacology is sufficient: many medications used to treat anxiety disorders, depression, and other mental illnesses also have implications for patients taking other medications as diverse as antihypertensives and birth control pills. Additionally, I suspect that the American Psychiatric Association is correct when they say it is a certain group of psychologists that is lobbying for this: I really don’t see any great clamoring from patients to grant this authority to psychologists.
Louisiana’s prescribing psychologists are limited in the types of drugs they can prescribe. They have to talk with the patient’s primary doctor to be able to do so, and they cannot prescribe narcotics – areas Blanco cited as protections for patients. Only psychologists who have a postdoctoral degree in psychopharmacology for studying drugs and areas like neuroscience and anatomy can write prescriptions under the new law, after passing a national proficiency test. A small group of Louisiana psychologists had completed the training before the law was passed, hoping they’d one day be able to prescribe medication. Psychiatrists and critics of the new law said the main university to offer a “medical psychology” postdoctorate program ranked in the bottom 10 of 183 schools nationwide offering psychopharmacology programs. They said the training isn’t sufficient to teach psychologists about harmful drug interactions when patients are taking medications for other conditions. Elaine LeVine, a prescribing psychologist in New Mexico, said her new authority helps her better manage care by allowing her to combine medication with therapy, instead of suggesting types of drugs to patients’ primary doctors and hoping the advice is followed. She is under scrutiny by a physician as part of New Mexico’s conditional licensing requirements.
The argument about long waiting lists for psychiatrists is bogus, in my opinion. The types of drugs that these prescribing psychologists are permitted to prescribe would be medications that in most jurisdictions are most often prescribed by family physicians and general practitioners. In my experience, many of these doctors are quite willing to collaborate with or take suggestions from knowledgeable psychologists, but I think that their medical knowledge provides an “extra layer of protection” for patients that is going to be removed if prescribing rights for psychologists becomes widespread. Make no mistake about it: These medications are invaluable in the treatment of common emotional-psychological disorders and in most cases are easy to prescribe and monitor, but they are also medications which under certain conditions can be dangerous. I see this issue as similar to the issue of childbirth with a midwife versus childbirth with an obstetrician: If all goes well and it’s an uncomplicated delivery, the midwife is going to do fine, but if something starts to go wrong tyhat patient is going to need access to someone with more knowledge and expertise in a hurry.
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