The implementation in January of the nation's first two laws granting prescriptive authority to psychologists was an historic milestone. Civilian psychologists are now prescribing in both New Mexico and Louisiana. In doing so, they follow in the footsteps of the pioneering Department of Defense (DoD) psychologists trained in the Psychopharmacology Demonstration Project.
This significant milestone, which APA has facilitated and supported, has major implications for the future of professional psychology. In this column I would like to focus on one implication, which may not be immediately apparent: the need for improved licensure mobility.
The promise of prescriptive authority--improving access to quality care for people who are underserved--would be enhanced if state governments more readily recognized the licensing credentials issued by other states. Consider this: The 10 DoD prescribing psychologists had mobility; they could practice and prescribe on military installations in whatever state they were assigned to by virtue of their military clinical privileges and their holding a license to practice psychology from any state. They did not and do not need to get newly licensed in every state in which they are stationed, in order to provide services to members of the armed forces and their dependents.
However, this federal model does not apply to our state-based system for the licensing of health professionals by state regulatory bodies. Proposing any type of national license raises complex political issues of states' rights. Yet this reality is small consolation to the hundreds of psychologists with postdoctoral training in psychopharmacology who are potentially available to practice as prescribing psychologists in underserved areas of New Mexico and Louisiana. Assuming a willingness to relocate by some of these practitioners, improvements in mobility could alleviate access-to-care problems in states where the need is greatest.
Advances in technology such as telehealth have provided a strong impetus toward improving licensure mobility in recent years. Are there any solutions on the horizon? It is encouraging to note that there have been some new approaches adopted as part of national and international policy developments in recent years, as noted in a chapter on mobility by Patrick H. DeLeon, PhD, JD, and Billie J. Hinnefeld, JD, PhD, in the book "Everything Students Need to Know about Licensure and Certification" (APA, in press).
Among the developments are these:
Mobility is now a reality for psychology in Canada. The Mutual Recognition Agreement of the Regulatory Bodies for Professional Psychologists in Canada has been in force since June 2001. Psychologists can move from one province to another and be licensed/registered in the new province more easily than before through this mutual recognition of credentials.
The dental profession has moved to a system of four regional licensing exams that are valid for the majority of states. This may be followed by the adoption of the Uniform National Dental and Dental Hygiene Exam.
In 2002 the U.S. government went on record urging telehealth advancements through licensure exemptions and multistate practice arrangements. This was done as part of the Health Care Safety Net Amendments of 2002 (P. L. 107-251).
Psychology, too, has made progress in facilitating licensure mobility:
The Certificate of Professional Qualification (CPQ), issued by the Association of State and Provincial Psychology Boards (ASPPB), is now accepted or in the process of being accepted by 48 states and provinces.
Credentialing by the National Register of Health Service Providers in Psychology streamlines licensure in 34 states and provinces.
Holding diplomate status from the American Board of Professional Psychology (ABPP) facilitates licensure in 30 jurisdictions.
These efforts are laudable and represent real steps forward. But, as APA has urged, more needs to be done. The information technology revolution has transformed the speed with which our world works and by which our expectations are guided. Speed is now measured in nanoseconds. Instantaneous communication around the globe is in the hands of every person with an Internet connection. When traditional geographic and temporal boundaries are transcended as a matter of daily routine, can we afford as a profession to be tied to arduous and time-consuming ways of recognizing credentials? I think the answer is clear.
The time has come for more jurisdictions to embrace a variety of mobility mechanisms. The time has also come for federal agencies serving the underserved to allow clinical privileging for prescriptive authority to psychologists holding a state certification to prescribe.