Bingo...and the reality is we create part of that access problem imo. There are a lot of psychiatrists who hang onto stable outpatients forever because they are...well...stable and easy and quick. If they were sent back to pcp to write prescription, that would free up more spots for the patients who are actually in crisis and need to be seen....*in* crisis...not later when they may not even need to be seen anymore.
I don't think the issue is so much that there is such a massive need for our services that we can't accomodate that need, although I would some would disagree with that. I think the allocation of our time and resources is just very poor.
This isn't necessarily the issue. There's a lack of cause and effect involved in this. I.e. the cause of lack of access is due to lack of provider's interest, but it's not due to a lack of provider. Psychologists are not really very interested in provide therapy for patients in crisis either, and when they do, they get paid very little. While there is a shortage for medication management, there's a real shortage for EVIDENCE BASED therapy for patients who need therapy, even though there is a huge oversupply of therapists.
The bottom line is even if psychologists had RX, they still wouldn't want to treat an undesirable population and it doesn't solve the access issue. Meanwhile, it may, as you said, hurt the bottom line for psychiatrists because now they are competing with the same pool of desirable patients. For something like APA/AMA, which is essentially a lobbying group, I don't see any reason why they wouldn't advocate for a position that's in the professional interest of the members. Now, APA also has an patient advocacy role, which may or may not conflict with the professional advocacy role, but clearly this is not at stake or else NAMI and pure patient advocacy groups would push for RxP. Right now it's a small lobby of RxP groups that are advocating fro RxP, with clearly their own agenda.
The situation isn't that simple. For instance, if we really want to solve the access problem, we can train RxPs but only limit their practice to a few access needy areas. But clearly that defeats the purpose of the law, which is to train RxPs to make MD salaries. Everyone has an implicit stake in this game.
Again, as you are not very optimistic about biological psychiatry we are gonna have to agree to disagree, but as biological psychiatry expands, the practice of psychiatry is becoming more and more medical, and it'll eventually become a special thing where it's just very clear that it's not possible to do something like RxP. That's really the ultimate solution to this problem. But before that happens we'll just have APA/AMA fight on our behave.
Here is the actual language from the current proposal, not wildly inaccurate declarations of fact....
