Politics — 30 August 2012

Psychologists have traditionally not been allowed to prescribe medications  for their patients, but some argue that giving them this right would be better  for patients, and is also vital to the future of the profession.

After a nearly 30-year push from psychologists, just two states, New Mexico  and Louisiana, have passed bills allowing psychologists who complete additional  education to prescribe. Last year, six states (Arizona, Hawaii, Montana, New  Jersey, Oregon and Tennessee), were considering similar bills.

Unlike psychiatrists, who can prescribe drugs, psychologists do not have  degrees in medicine, and opponents argue that this makes them unqualified to  prescribe powerful medications. But there are not enough psychiatrists to go  around, and some say psychologists could make up for this dearth, and improve  patients’ access to care.

Now, psychologists say they fear that the movement to integrate health care services could leave psychologists out of  mental health care.

New health care legislation “is specifically focused on getting teams of  doctors to work together,” said Stephen Ragusea, a clinical psychologist in Key  West, Fla. “In order for psychologists to fit into that model, we need to know  more about psychoactive medications, and how to integrate psychology with  overall medical care,” Ragusea said.

Ragusea noted that other health care professionals without M.D. degrees, such  as nurse practitioners and physician assistants, have prescribing rights. “I  have some concerns that psychologists may be replaced with those people, if we  cannot prove our value to society overall,” Ragusea said.

Prescribing benefits

In 2002, New Mexico became the first state to allow psychologists to  prescribe, followed by Louisiana in 2004. In both states, psychologists must  earn a master’s degree in psychopharmacology, which is the study of how psychiatric drugs act on the body, and then must work  for one year under supervision.

Psychologists in the military can also prescribe medications if they complete  the appropriate training.

Elaine LeVine, of Las Cruces, N.M., said she became a prescribing  psychologist because she wanted to understand the effects of the medications her  patients were using.

Many of her patients say they prefer seeing one person for both their talk therapy and medications, she said.

In addition, she often uses her prescribing privileges to take people off  medications who have been put on them unnecessarily, a problem she runs into  particularly with child patients. “The right to prescribe is also the right to  un-prescribe,” LeVine said.

Before the New Mexico bill was passed, there were about 100 psychiatrists in  the state, LeVine said. In the last 10 years, about 30 psychologists have  completed the education to prescribe, a number of whom live in small towns. “You  can see it really has increased access to care,” LeVine said.

About 70 psychologists in Louisiana can prescribe, and 100 in the military,  LeVine said.

Many more psychologists have completed the training, but their states have  yet to pass laws giving them prescribing rights, Ragusea said.


Others argue that psychologists do not know enough about the human body or  medical diagnoses to be able to prescribe psychiatric drugs.

By the time psychiatrists have completed medical school and a four-year  residency, they have logged more than 10,000 hours of training, said Dr. Lisa  Rone, an assistant professor of clinical psychiatry at Northwestern University  Feinberg School of Medicine. In contrast, prescribing psychologists receive  about 450 hours of psychopharmacology training, Rone said.

“We do not feel that this qualifies them for safely prescribing medication,”  she said.

In addition, psychologists have little, if any, experience diagnosing  illnesses such as epilepsy and cancer that can produce  psychiatric symptoms, said Dr. Jeremy Lazarus, president of the American Medical  Association.

“The privilege of prescribing these powerful medications requires such  intensive training and education because the stakes are so high,” Lazarus said  in a statement.

Psychologists counter that, in the 10 years they have been prescribing, there  has not been one complaint to state licensing boards or word of a negative  incident, Ragusea said.

And a review of prescribing psychologists in the military found that, while  psychiatrists involved in the training initially had reservations about the  idea, many rated the care of the prescribing psychologists as good to excellent,  according to a report from the National Alliance on Mental Illness (NAMI).

Impact of laws

Michael Fitzpatrick, executive director at NAMI, said the first steps to  improve patient care should be to provide better psychopharmacology training to  general practitioners, and then to train more nurse practitioners and  physician’s assistants to prescribe.

“Jumping immediately to giving prescribing rights to psychologists… doesn’t  make sense to us,” Fitzpatrick said. For prescribing drugs,  “our comfort level is higher with people who are trained in medicine,”  Fitzpatrick said. NAMI receives much of it’s funding from pharmaceutical  companies.

The real impact of the laws in New Mexico and Louisiana are not yet known,  and should be studied before more laws are passed, Fitzpatrick said.

If psychologists do get the right to prescribe in all states, it will likely  be a long way off, said Ragusea, who noted it took many years for psychologists  to be able to earn the right to practice independently.

“Medicine is extremely protective of its turf,” Ragusea said.

As first appeared on Fox News, 28 August 2012

Read more: http://www.foxnews.com/health/2012/08/28/psychologists-argue-for-right-to-prescribe-medicines/#ixzz24zlaWkCm


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