New Mexico becomes first state to gain Rx privileges

In a landmark move this winter, the New Mexico legislature granted prescription privileges to trained psychologists. The New Mexico House of Representatives passed the bill 56 to 11 and then just a couple weeks later on Feb. 12, the Senate passed it 29 to 9.

Finally, on March 5, the governor signed the bill into law, making New Mexico the first state in the country to give properly trained psychologists the right to prescribe.

The win is a milestone for psychology--one that took its fair share of long days and nights filled with strategizing and relationship-building by dedicated members of the New Mexico Psychological Association (NMPA).

"We've been working year 'round on this--educating legislators, responding to concerns and gaining further support," says Elaine LeVine, PhD, chair of the NMPA committee on prescription privileges.

The New Mexico bill also represents what Russ Newman, PhD, JD, APA's executive director for practice, hopes will be a domino effect with neighboring states, such as Texas and Arizona where the RxP movement has been active.

Advocates have long believed that with appropriate training, psychologists can provide physical as well as psychological interventions to meet patients' needs--especially in rural areas where services are scarce. Since 1995, when APA's Council of Representatives made prescription authority a major policy directive, 13 states have introduced RxP legislation and in 1998 Guam passed legislation that allows psychologists to prescribe in collaboration with physicians. New Mexico's success could be the beginning of a new legislative era in the movement.

"The win is great on two levels," says Newman. "For New Mexico, it's a state in need of services and this is a good way to meet those needs. For the field, this is a really nice example of psychology's continuing growth and evolution as a comprehensive health profession."

Filling an unmet need

Prescription authority in New Mexico had been passed by the House last year but was shelved when the legislative session ended before the Senate could vote. Before the bill was ever introduced and even after the near miss in the Senate, NMPA members like Mario Marquez, PhD, were building support.

"To me, the bottom line is we developed relationships with legislators," he says. "We educated them about psychology and we made friends with them in some cases."

This year, NMPA got the governor's ear. After a scheduled debate between opponents and proponents of RxP, Governor Gary Johnson (R) decided the issue was compelling and called the bill up for the legislature to consider. The relationships Marquez and others worked so hard to cultivate resulted in what he says was "solid support" in the legislature.

To further aid the RxP crusade, NMPA joined forces with the New Mexico Medical Society, previously an opponent, to develop a compromise. It worked. The Medical Society recognized that psychologists could fill a need in the state, where the number of psychiatrists outside urban areas--Santa Fe and Albuquerque--is 18 compared with more than 170 psychologists. The result was a bill supported by both groups.

"We're thrilled we're doing this together," says LeVine.

The crux of the compromise is summed up in a few factors:

• The Board of Psychology Examiners and the Board of Medical Examiners will form an ad hoc group to work together to determine how to implement the training requirements for the psychopharmacology curriculum, practicum and examination.

• Trained psychologists will receive a two-year "conditional prescribing" license, during which time they'll be supervised by a medical practitioner, such as a physician, psychiatrist or nurse practitioner.

• After undergoing an independent review, psychologists will move from the conditional license to an independent license to prescribe.

• Psychologists must obtain at least 450 classroom hours of instruction in areas such as pharmacology and complete a 400-hour/100-patient practical training.

• Everyone is accountable. The Board of Psychology Examiners and the Board of Medical Examiners must report on their progress--or any potential problems--in developing regulations to the legislature next year and in 2004.

"We have good faith that this is really a joint effort," says LeVine, who admits that the compromise was tough at times. At first, Medical Society representatives wanted psychologists to complete a physician's assistant program--a suggestion LeVine says was born out of their experience and training in the medical model. In the end, however, psychologists and physicians agreed on a program that builds on psychologists' doctoral level training.

The New Mexico Psychiatric Association, not surprisingly, strongly opposed the bill. The American Psychiatric Association's Patient Defense Fund ran a full-page ad in the Santa Fe New Mexican with the headline, "You wouldn't do it to your dog, so why would you do it to your child?" The ad implied that psychologists could not be trained nor trusted to prescribe medications.

Despite the staunch opposition, the bill passed. And the Medical Society came out on psychology's side. Their support, says LeVine, and the fact that psychologists "are really involved and really invested in helping people and the people in the legislature can sense that," helped pass this landmark legislation.