DRAMATIC CHANGE IN THE WINDS - HPA ON THE CUTTING EDGE
During the last legislative session, HPA, in collaboration
with the Hawaii Primary Care Association, nearly obtained
prescriptive authority (RxP) for those colleagues working within
federally qualified community health centers. And without question,
the legislatively mandated RxP Task Force was a major accomplishment
and we look forward to their recommendations. RxP is critical for
the future of our profession. Hopefully, this year increasing
numbers of colleagues will meet personally with their legislators on
behalf of the RxP movement.
Jim Quillin, President of the Louisiana Psychological
Association: Louisianas Medical Psychology statute was signed into
law on May 6, 2004, and the rules governing this landmark statute
were finalized on January 20th of this year clearing the way for the
certification of medical psychologists (MPs) under state law. This
represented the culmination of a decade of hard work by a small group
of extremely dedicated psychologists who believed in themselves and
in their ability to effect progressive health care change through the
political process. With the unfailing support of the APA Practice
Directorate and CAPP, LPA and its sister organization, the Louisiana
Academy of Medical Psychologists (LAMP), forged a partnership that
brought to fruition, after four legislative sessions, the countrys
second statute authorizing psychologists with specialized training
the authority to prescribe medications. On February 18th of this
year, one of LAMPs founding members, John Bolter, became the first
civilian psychologist in the United States to issue a prescription
under state statute. In all, it was an exhilarating ride and one
which all of us will forever remember not only for its outcome but
also for the process.
We are now embarked upon the implementation of this
historical statute. A total of 17 medical psychologists are now
authorized to prescribe here in Louisiana, and by the end of this
month, only seven months into this new law, we anticipate there will
be a total of 18 to 20 MPs. By Summers end, no less than 25 MPs
will likely be practicing in Louisiana, and it is my hope that by the
end of the year the remainder of those who have completed their
training thus far will be doing so as well. A new class of
psychologists is underway and being trained, and the next wave of
MPs, will follow in due time. I also hope to be able to report to
you in the near future another groundbreaking first, the
credentialing of an MP to prescribe as part of the medical staff of a
hospital. We have also been working with the insurance industry and
I believe that I will soon have the pleasure of announcing an
important breakthrough in the reimbursement of services provided by
MPs, one that may well extend to other states for qualifying
psychologists.
To date, we are successfully feeling our way through the
logistics required to fully realize the potential of our law.
Louisiana is one of a number of states that require a state
Controlled and Dangerous Substance Permit before application can be
made for a DEA number. This process has gone very smoothly and, with
our DEA numbers in hand, we are now authorized to prescribe any drug,
Schedule II through V, that has a recognized use (including
off-label) in the management of any psychiatric disorder listed under
either DSM or ICD. MPs, however, are not permitted to prescribe
narcotics, agents which are specifically defined in our law as any
...natural or synthetic opiate analgesic used for the treatment of
pain. We are required to use the abbreviation MP following our
academic degree (Ph.D. or PsyD.) on all prescriptions and all medical
records we generate, and the Louisiana State Board of Examiners
(LSBEP) provides the Louisiana State Pharmacy Board a roster of all
MPs in the state. Each of our psychology license numbers have been
modified by LSBEP and are now followed by MP so that our
designation can quickly and easily be determined. The board also
requires copies of our state Controlled and Dangerous Substances
permits, DEA numbers and Basic Life Support for Health Care Providers
certificates.
To a person, all current MPs have enjoyed excellent
relationships with pharmacists, all of whom, across the state,
received a memo from the Pharmacy Board earlier this year advising
them of MPs as a new class of prescribers in Louisiana. Taking a tip
from the Executive Director of that Board, I contacted many of the
pharmacies in my area and provide them all the information necessary
for them to put me into their systems. Several of them now fax or
call my clinic to remind me of expiring prescriptions so that I can
discontinue, change or refill as needed. It has also been gratifying
to see that nonpsychiatric physicians appear to accept and even
welcome MPs as partners in the delivery of health care. Whereas
organized medicine has been obliged to oppose psychology in this
movement, partly in deference to their psychiatric colleagues and
partly out of a sense that medicines monopoly on health care is
waning, rank and file MDs, in my experience, are concerned not with
turf issues but rather with providing quality care to their patients.
We are not a threat; we are their allies and are being increasingly
accepted as such. Patients appear absolutely thrilled with the
ability of MPs to prescribe their psychotropic medications. It has
freed them of the onerous requirement of seeing two doctors each time
a prescription is needed while the close coordination of care between
their MP and MD helps ensure optimized outcomes. As of this writing,
MPs here in Louisiana have written over 1,000 prescriptions
representing nearly 25,000 treatment days, all without incident. We
are prescribing all classes of psychotropic medications.
As for myself, this implementation period has been
interesting. I find that I am conservative in my prescribing habits,
adhering to the age old admonition to start low and go slow when
treating patients psychopharmacologically. My first official act
as an MP actually was to obtain labs on a new patient I suspected of
thyroid disease and refer the patient whose studies were indeed
abnormal. Subsequently, I have prescribed for all classes of
psychotropic medications across all relevant schedules. Still, all
in all, patients have a better than 50-60% chance of leaving my
clinic without a prescription so far, as psychotherapeutic/behavioral
management was indicated and sufficed. Those for whom medication is
necessary report that they find it refreshing that the doctor who
prescribes for them also takes the time to listen to them and to
approach their care in a more holistic manner. I understand that
this is similar to the experience of the DoD graduates. It will be
interesting to track this over the longer term.
As Ive started prescribing, Ive found myself pondering
afresh the concern of some that we are medicalizing psychology. To
be brief, such concerns, while certainly understandable, appear to be
unnecessary. While some of our new professional activities are
unmistakably medical in character (i.e., vital signs/review of
systems/labs, evaluation of drug-drug and disease-drug interactions,
therapeutic monitoring, etc.), the medical in medical psychology is
an adjective that modifies rather than defines who and what we are
psychologists. The opportunity to provide a broader range of
therapeutic options to my patients certainly has not seemed to
diminish my sense of professional identity. Case in point, my oldest
daughter, a third year medical student, was able to spend a few days
at home recently before starting her general surgery rotation. While
she doesnt seem to have any interest in psychiatric medicine, she
asked if she could shadow me, with the necessary patient consents, in
order to get a better feel for real life psychopharmacology. She
commented at the end of the day on how numerous patients had pulled
her aside and remarked that they hoped that as a future physician she
too would take the time to listen to and treat patients like her
father. She was clearly impressed and seemed to come away with a
better recognition of the importance of integrating psychological and
medical factors in patient care. It is clearer to me now more than
ever that the core of the healing arts, the therapeutic g-factor if
you would, is still to be found in that somewhat mysterious, elusive
bond of the doctor-patient relationship. I dont find that I am
abandoning my psychological roots now that I am actively prescribing
and practicing as a medical psychologist. For me, the tide seems
like it is running in the other direction I think Im discovering
them anew. Go figure. Aloha,
Pat DeLeon, former APA President HPA August, 2005
During the last legislative session, HPA, in collaboration
with the Hawaii Primary Care Association, nearly obtained
prescriptive authority (RxP) for those colleagues working within
federally qualified community health centers. And without question,
the legislatively mandated RxP Task Force was a major accomplishment
and we look forward to their recommendations. RxP is critical for
the future of our profession. Hopefully, this year increasing
numbers of colleagues will meet personally with their legislators on
behalf of the RxP movement.
Jim Quillin, President of the Louisiana Psychological
Association: Louisianas Medical Psychology statute was signed into
law on May 6, 2004, and the rules governing this landmark statute
were finalized on January 20th of this year clearing the way for the
certification of medical psychologists (MPs) under state law. This
represented the culmination of a decade of hard work by a small group
of extremely dedicated psychologists who believed in themselves and
in their ability to effect progressive health care change through the
political process. With the unfailing support of the APA Practice
Directorate and CAPP, LPA and its sister organization, the Louisiana
Academy of Medical Psychologists (LAMP), forged a partnership that
brought to fruition, after four legislative sessions, the countrys
second statute authorizing psychologists with specialized training
the authority to prescribe medications. On February 18th of this
year, one of LAMPs founding members, John Bolter, became the first
civilian psychologist in the United States to issue a prescription
under state statute. In all, it was an exhilarating ride and one
which all of us will forever remember not only for its outcome but
also for the process.
We are now embarked upon the implementation of this
historical statute. A total of 17 medical psychologists are now
authorized to prescribe here in Louisiana, and by the end of this
month, only seven months into this new law, we anticipate there will
be a total of 18 to 20 MPs. By Summers end, no less than 25 MPs
will likely be practicing in Louisiana, and it is my hope that by the
end of the year the remainder of those who have completed their
training thus far will be doing so as well. A new class of
psychologists is underway and being trained, and the next wave of
MPs, will follow in due time. I also hope to be able to report to
you in the near future another groundbreaking first, the
credentialing of an MP to prescribe as part of the medical staff of a
hospital. We have also been working with the insurance industry and
I believe that I will soon have the pleasure of announcing an
important breakthrough in the reimbursement of services provided by
MPs, one that may well extend to other states for qualifying
psychologists.
To date, we are successfully feeling our way through the
logistics required to fully realize the potential of our law.
Louisiana is one of a number of states that require a state
Controlled and Dangerous Substance Permit before application can be
made for a DEA number. This process has gone very smoothly and, with
our DEA numbers in hand, we are now authorized to prescribe any drug,
Schedule II through V, that has a recognized use (including
off-label) in the management of any psychiatric disorder listed under
either DSM or ICD. MPs, however, are not permitted to prescribe
narcotics, agents which are specifically defined in our law as any
...natural or synthetic opiate analgesic used for the treatment of
pain. We are required to use the abbreviation MP following our
academic degree (Ph.D. or PsyD.) on all prescriptions and all medical
records we generate, and the Louisiana State Board of Examiners
(LSBEP) provides the Louisiana State Pharmacy Board a roster of all
MPs in the state. Each of our psychology license numbers have been
modified by LSBEP and are now followed by MP so that our
designation can quickly and easily be determined. The board also
requires copies of our state Controlled and Dangerous Substances
permits, DEA numbers and Basic Life Support for Health Care Providers
certificates.
To a person, all current MPs have enjoyed excellent
relationships with pharmacists, all of whom, across the state,
received a memo from the Pharmacy Board earlier this year advising
them of MPs as a new class of prescribers in Louisiana. Taking a tip
from the Executive Director of that Board, I contacted many of the
pharmacies in my area and provide them all the information necessary
for them to put me into their systems. Several of them now fax or
call my clinic to remind me of expiring prescriptions so that I can
discontinue, change or refill as needed. It has also been gratifying
to see that nonpsychiatric physicians appear to accept and even
welcome MPs as partners in the delivery of health care. Whereas
organized medicine has been obliged to oppose psychology in this
movement, partly in deference to their psychiatric colleagues and
partly out of a sense that medicines monopoly on health care is
waning, rank and file MDs, in my experience, are concerned not with
turf issues but rather with providing quality care to their patients.
We are not a threat; we are their allies and are being increasingly
accepted as such. Patients appear absolutely thrilled with the
ability of MPs to prescribe their psychotropic medications. It has
freed them of the onerous requirement of seeing two doctors each time
a prescription is needed while the close coordination of care between
their MP and MD helps ensure optimized outcomes. As of this writing,
MPs here in Louisiana have written over 1,000 prescriptions
representing nearly 25,000 treatment days, all without incident. We
are prescribing all classes of psychotropic medications.
As for myself, this implementation period has been
interesting. I find that I am conservative in my prescribing habits,
adhering to the age old admonition to start low and go slow when
treating patients psychopharmacologically. My first official act
as an MP actually was to obtain labs on a new patient I suspected of
thyroid disease and refer the patient whose studies were indeed
abnormal. Subsequently, I have prescribed for all classes of
psychotropic medications across all relevant schedules. Still, all
in all, patients have a better than 50-60% chance of leaving my
clinic without a prescription so far, as psychotherapeutic/behavioral
management was indicated and sufficed. Those for whom medication is
necessary report that they find it refreshing that the doctor who
prescribes for them also takes the time to listen to them and to
approach their care in a more holistic manner. I understand that
this is similar to the experience of the DoD graduates. It will be
interesting to track this over the longer term.
As Ive started prescribing, Ive found myself pondering
afresh the concern of some that we are medicalizing psychology. To
be brief, such concerns, while certainly understandable, appear to be
unnecessary. While some of our new professional activities are
unmistakably medical in character (i.e., vital signs/review of
systems/labs, evaluation of drug-drug and disease-drug interactions,
therapeutic monitoring, etc.), the medical in medical psychology is
an adjective that modifies rather than defines who and what we are
psychologists. The opportunity to provide a broader range of
therapeutic options to my patients certainly has not seemed to
diminish my sense of professional identity. Case in point, my oldest
daughter, a third year medical student, was able to spend a few days
at home recently before starting her general surgery rotation. While
she doesnt seem to have any interest in psychiatric medicine, she
asked if she could shadow me, with the necessary patient consents, in
order to get a better feel for real life psychopharmacology. She
commented at the end of the day on how numerous patients had pulled
her aside and remarked that they hoped that as a future physician she
too would take the time to listen to and treat patients like her
father. She was clearly impressed and seemed to come away with a
better recognition of the importance of integrating psychological and
medical factors in patient care. It is clearer to me now more than
ever that the core of the healing arts, the therapeutic g-factor if
you would, is still to be found in that somewhat mysterious, elusive
bond of the doctor-patient relationship. I dont find that I am
abandoning my psychological roots now that I am actively prescribing
and practicing as a medical psychologist. For me, the tide seems
like it is running in the other direction I think Im discovering
them anew. Go figure. Aloha,
Pat DeLeon, former APA President HPA August, 2005
