This is from the American Psychological Assn Div 55 listserv, enjoy!
ASAP READER vol 3 #15 11-14-2004
Greetings ASAP Readers,
The virtual declaration of war against psychologists seeking prescriptive authority by Michelle Riba, President of the American Psychiatric Association, comes as no surprise. It should be a surprise only to those that have not been paying attention. My only surprise is the lack of a clear response from our colleagues. Sure, there were cries of outrage from some. There were conciliatory responses from others urging more educative efforts toward psychiatry. The educational response we should see is more psychologists signing up for training courses to document their expertise in psychopharmacology and the combined treatment of mental conditions with psychotherapy and psychotropics!
Riba?s establishment of a warchest was not about education (Psychiatric News Nov 5, 2004). It was about money and power?power to control the mental health market and incomes. If anyone missed this point, they need a refresher course in Business 101. It is time to restate basic health economics regarding the two conflicting trends: 1.) capturing more market share through increased specialization; 2.) reducing costs by treating health services as commodities by using evidence based treatment formulas that can be applied by masters level or even bachelor level technicians. Our academic psychological colleagues are the leaders of this latter thrust. Unless doctoral level psychologists can document they are mental health specialists, they will continue to compete with masters level therapists for the mental health market. Some of these masters and bachelor therapists can even prescribe medications e.g., mental health nurse practitioners and physician assistants.
The Academy of Medical Psychology offers a certificate as a Medical Psychologist to those who complete RxP training requirements and pass a national examination. The Academy is in process of creating a Board of Medical Psychology Examiners that will offer a Diplomate in Medical Psychology. For information go to Google and search Academy of Medical Psychology.
Many psychologists have held off obtaining training in psychopharmacology thinking they will wait until their state obtains prescriptive authority. This mistake is not being made in other professions. Physician Assistants and Nurse Practitioners, Optometrists, Podiatrists and other professions have sought the training first and then achieved the legal authority to prescribe. Presently, Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants are consolidating their positions in the health and mental health markets as prescribing therapists for mental conditions. Psychologists are fiddling while other health professions are eating their lunch, their children?s college education and their retirement funding. It is time for psychologists to mobilize and become a full service diagnosing and treating profession.
In Arizona psychology ranks behind every major health profession in future demands for health services?behind Physician Assistants; Nurses; Mental Health and Substance Abuse Social Workers; Health and Diagnosing and Treating Practitioners, All Other; Psychiatrists; Mental Health Counselors; Rehabilitation Counselors. The anticipated growth for PAs is 78%, Nurses 58%, All other Health Diagnosing and treating professions 46%, Psychiatrists 39% and Psychologists 30%.
For documentation of market trends look at the projected job markets for various health professions. The US Bureau of Labor Statistics (BLS) annually forecasts the number people with specific training over the next 10 years for each state. Then the BLS summarizes this data on employment projections and publishes it as its Occupational Outlook Handbook. The data for 2003-2013 occupation projections are at
www.workforce.az.gov. On the Arizona Workforce Informer home page at the bottom of the left hand column there is a ikon labeled "Related Sites." Click on it. The next page click on USMap Linked to All States LMI Websites (LMI= Labor Market Information). Click on the state of your choice and you will be able browse to see the projections of job opportunities in psychology in your state for the next 10 years. Some states even break this data down by counties. The Standard Occupational Classification System used by BLS lists psychologists under three different codes 19-3030 (psychologists), 19-3031 (clinical, counseling and school psychologists), and 19-3032 (industrial psychologists). Sadly, BLS does not consider psychology as a "diagnosing and treating" health profession. Psychology is classified as a social science instead.
APA?s efforts to have BLS change its classification of psychology to include its position as a "diagnosing and treating" health profession has fallen on deaf ears in BLS. [The Health Profession Classifications also includes "Technicians" and "Treating" categories in addition to "diagnosing and treating."] Perhaps we can prevail on one of our four psychologists Congressional Representatives to take this issue on with BLS. [Another side bar ? There are 8 Congressional Representatives with medical degrees and one Senator, Frist. Oklahoma elected Coburn who will join Frist in the Senate.]
For the past 15 years I have been advocating psychology attempt to determine what the market for psychological expertise is and refine our training programs to meet these societal needs. This was the theme of my APA Presidential address in 1992. The APA Board of Directors will be considering such a proposal at its December 2004 meeting according a response from Paul Nelson of the Educational Directorate.
In our personal communications, Pat De Leon brought to my attention how military personnel were being screened for mental health risks for duty in Iraq by pharmacy technicians. If the soldier is taking a psychotropic medication they are considered a risk. This just one example of the use of lesser-trained non-mental health personnel are used for mental health determinations. While this screening procedure makes sense, it should not be the only criterion for military assignments.
John Caccavale posted on this ASAP listserve (11-13-2004) an example of specialization encroachment of physicians on psychology. SCAN is an internet website for locating medical specialists in California. When you search SCAN for a psychologist you are referred to a list of non-psychiatric physicians. See the number of MDs listed as psychologists in Dr. Caccavale?s posting. Under California law physicians are not considered psychologists because they are not trained as such. Dr. Caccavale inquired about being put on the list of psychologists and was told they would be glad to put him on the list as soon as he affiliated with a medical group. This would be a restraint of trade requirement in my judgment.
The declaration of war on psychology by Riba opens up a myriad of opportunities for psychology to assert itself at the local state and national levels. Another example of an opportunity in California is that the state has never enforced its law giving psychologists staff privileges in state hospitals there. It is important that psychologist assert their professional expertise in every way we can. It is not just about prescriptive authority. We have become complacent in my ways. We must band together to eliminate barriers to our patient?s health care wherever we find artificial injustices. Forming local chapters of ASAP (Division 55) could be a first step in this process. By contacting your legislator in you our home district you will find these artificial barriers. When the legislator find he/she can help you as a constituent they will be more apt to try to help you in other ways as well. It only takes 5 members of Div 55 to form a local Chapter of the Division. Local Chapters can become the focal point to spearhead state initiatives in RxP and other issues.
Psychologists have forgotten that all politics is local. Political action must begin at home. This is why medicine relies heavily on county medical societies to form political alliances and be the backbone of its political clout for its state and national agendas. The success of the Practice Directorate has resulted in over-reliance on APA for solving local problems.
For the past few years we have focused on getting issues put on the agendas of state psychological associations and then have the state representative to APA Council place the issues on the APA Board and Committee agendas. This advocacy formula is cumbersome and takes an inordinate amount of time for an issue to become an actionable item on APA?s agenda. Even when the item is passed and funded it takes time to recruit the special staff to develop and implement the action plan. Often, the action plan requires active participation by the state association and we have come full circle. In the meanwhile our members
become disgruntled waiting for APA to act and disaffect from our organizations. They do not realize that they are failing themselves and blaming others instead.
If this push of agendas up to APA is the only means of producing change, then I fear for our profession. We must ardently support local psychologists banding together to deal with the issues that face them as a profession. When we have local action, it stimulates the excitement that draws members into the organization. This is where Division Chapters have a place in shaping professional trends in psychology.
