Making the point on prescriptive authority
By Dr. Russ Newman
APA Executive Director for Practice
Recently, I was asked by Physician's Weekly to present the "pro" viewpoint for a "Point-Counterpoint" on the question, "Should psychologists have prescribing privileges?" Physician's Weekly is an independent publication for physicians and policy-makers, with a readership around 300,000. The publication appears online at www.physiciansweekly.com and also takes the form of posters distributed to hospitals, which typically post each week's issue in the doctor's lounge.
I was given a 300-word limit to make the case for appropriately trained psychologists to prescribe. Richard K. Harding, MD, president of the American Psychiatric Association, was invited to take the "con" stance. Despite the word limit, the column seemed to be a good opportunity to share with physicians some of our perspective on why we are pursuing a prescriptive authority agenda.
The online version of the publication polled readers on whether psychologists should have prescribing privileges and found 47 percent voted "yes" while 53 percent voted "no." The text of the "Point-Counterpoint" follows.
Should psychologists have prescribing privileges?
YES
Russ Newman, PhD, JD
Executive Director for Professional Practice, APA
Properly trained psychologists should be authorized to prescribe drugs as part of their broad range of treatments for mental-health disorders.
Prescribing psychologists' training involves much more than psychopharmacology. It also includes neuroanatomy, neurophysiology, clinical pharmacology, pharmacology, pathophysiology,
pharmacotherapeutics, pharmacoepidemiology, physical and lab assessments, as well as a clinical practicum.
A U.S. Department of Defense study conclusively demonstrated psychologists' ability to prescribe safely and effectively. All four independent evaluations concluded that psychologists can be trained to prescribe medications safely in a format alternative to traditional medical school. An evaluation by the American College of Neuropsychopharmacology (ACNP) found that program graduates "filled critical needs and performed with excellence wherever they served."
The Surgeon General has identified gaps in the delivery of mental-health services. Prescribing psychologists would help fill these gaps, particularly in the 444 U.S. counties that have psychologists but no psychiatrists.
A 1999 American Journal of Psychiatry study showed that integrating psychotherapy and medication by one provider was more cost effective than splitting care between providers.
Prescribing psychologists would not be "mini-psychiatrists." According to ACNP, the Department of Defense training produced "psychologists with a value-added component prescriptive authority provides. They continued to function very much in the traditions of clinical psychology...but a body of knowledge and experience was added that extended their range of competence."
NO
Richard K. Harding, MD
President, American Psychiatric Association
Safe and effective use of potent psychotropic medications requires extensive medical training and a thorough understanding of the brain and body.
Careful diagnosis of mental disorders like clinical depression or schizophrenia requires as extensive medical education and training as is needed to diagnose other medical illnesses such as diabetes or cancer.
It is commonly known that half of all mentally ill patients also have other serious medical conditions requiring additional drugs. Therefore, knowing when not to prescribe is as important as knowing when and what to effectively prescribe.
Like other physicians, psychiatrists spend over 12 years in post-secondary education. During their 10,000 hours of training, psychiatrists manage the care of 200 to 300 patients with a wide range of physical and emotional illnesses.
Psychologists' education deals with human behavior--not human biology and pathology. They can earn a PhD by taking a single course in the biological basis of behavior. The self-serving, self-designed proprietary prescribing programs proposed by organized psychology simply cannot train psychologists to prescribe psychotropic drugs appropriately.
No state permits psychologists to prescribe medications. There is no societal need for more prescribing professionals. The needs of rural and other underserved patients can best be met through collaboration between psychiatrists and other medical professionals.
Psychologists, like social workers, mental-health counselors, and family therapists, should be proud of their training in human behavior, but they are not physicians. No legislative action can qualify them to prescribe drugs to our most vulnerable population: persons with mental illnesses. Giving psychologists the prescription pad would be bad medicine.
Reprinted with permission from Physician's Weekly, Volume XVIII, Number 25 (July 2, 2001). All rights reserved.
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