Having more prescribers CAN provide rural access to care, the person would just need to travel….like they do to see their CV surgeon, oncologist, etc. As a neuropsychologist I have people travel from around the state and the surrounding 3-4 states to see me. Is that ideal…no, but I can still provide them a serve that they wouldn't otherwise have had access to in their small town. I consulted with a rural hospital that imports specialists on different days so the "locals" can be seen. Mondays are for diabetes-related cases, Tuesdays are for psychiatric cases, Wednesdays are for phys rehab cases, etc. My colleague covers their clinic one day a week and does eval and consultation because there are literally no other providers within 30+ mi for any kind of psychotherapy and 75-100+ for a neuropsychologist (who already has a 2-6+ mon waitlist).Well, I guess you are conceding that the rural access claim is indeed phony.
Telehealth…that is one option. Will I concede "far better trained psychiatrists"….no, not based on what I've experienced in 4 different hospital systems across 4 different states. I've worked with some excellent psychiatrists, but I've also worked with psychiatrists who I wouldn't wish upon an enemy. I previously worked with a psychiatrist who was a surgeon in their country and they became a psychiatrist because they didn't match into any surgery residencies and had psychiatry as their backup. Is that a "far better trained" prescriber than a psychologist who went through 4yr undergrad psych, 4-6yr of grad school, fellowship….THEN a MS, more supervision, and then collaborates w. a physician?As for rural access, the far more appropriate alternative is telepsychiatry, so that far-better trained psychiatrists can cover broad areas. The VA and the Bureau of Prisons are using it a lot. A couple of psychiatrists are covering large swaths of western Nebraska. No need to let internet-trained part-timers prescribe drugs.