Feature

Physician groups need to work collaboratively with psychologists and other health professionals on meeting the unmet health-care needs of the American public--including mental health care--rather than trying to limit the scope of that care, said APA Executive Director for Professional Practice Russ Newman, PhD, JD, speaking for APA at a June teleconference announcing the formation of the Coalition for Patients' Rights.

Some two dozen health professional associations, including APA, formed the group this spring to oppose efforts of the American Medical Association (AMA) and other physician groups such as the American Psychiatric Association to limit the scope of practice of health-care professionals. What's new in the struggle--and what prompted the formation of the coalition--was a move by AMA and other physicians' groups earlier this year to collectively fund and form the Scope of Practice Partnership to oppose scope-of-practice expansion by licensed health professionals who are not medical doctors or doctors of osteopathy.

The Coalition for Patients' Rights represents nearly 3 million professionals in a variety of health-care fields ranging from physical therapists to nurse-midwives.

Despite opposition from physicians' groups, psychologists have already expanded their scope of practice to obtain prescriptive authority for appropriately trained psychologists in Louisiana and New Mexico, Newman said, noting that such initiatives are part of psychology's long-standing effort to address unmet needs for mental health services.

"With the ability to prescribe, psychologists have been able to help improve access to needed mental health services where waiting times to see a psychiatrist can range from several weeks to several months," said Newman, emphasizing that since "medical psychologists" in Louisiana gained regulations in 2005 enabling them to prescribe medications, they have written more than 10,000 prescriptions without incident in that state alone.

Unmet needs exist in both rural and urban areas, Newman noted. As one example, the Tennessee Psychological Association found that people in the state-run health insurance system, TennCare, wait almost 12 weeks to see a psychiatrist, with waiting times for people covered by other health plans in the state's urban areas lasting an average of four weeks, Newman said.

Besides opposing prescriptive authority for psychologists, organized medicine continues to try to prevent psychologists from practicing to the full extent of their licensed scope of practice in hospitals. In California, a medical association sued to block a state agency from issuing regulations enabling psychologists to practice fully and independently in state hospitals, he said.

Those actions are part of a historical pattern of organized psychiatry, a member of AMA's Scope of Practice Partnership, to attempt to restrain psychologists' scope of practice, said Newman. He noted,for example, that organized psychiatry opposed independent outpatient treatment by psychologists in the 1960s and 1970s.

During the teleconference, held to brief reporters about the formation of the coalition, Newman spoke along with Rose Gonzalez, a registered nurse and director of government affairs for the American Nurses Association, and Mitch Tobin, JD, senior director of professional practice affairs for the American Association of Nurse Anesthetists.

Gonzalez said nurse practitioners have fought state-level scope-of-practice battles over physician efforts to limit the number of nurse practitioners a physician can collaborate with, and physician efforts to limit how nurse practitioners can prescribe medicine. Tobin said nurse anesthetists are constantly fighting attempts by organized medicine to impose state-level supervision requirements, despite a proven track record of safe treatment of patients.

In response, the Coalition for Patients' Rights will share strategies on how to fight such state-level attempts to limit scope of practice. It will also present AMA with a collective voice to oppose its efforts, bring public awareness to the initiative and offer the prospect of dialogue on the issue, Newman said.

He argued that only one real fix exists for the nation's currently disarrayed and fragmented health-care system: integrated, interdisciplinary, collaborative care delivered to patients by health-care professionals working as a team.

"Now more than ever is the time for all health-care professionals to work together, not against each other, to provide the level of treatment our patients deserve," he said.