Should pyschologists be allowed to prescribe medication?

[Yogi Bear]

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Do you think psyschologists (PhD) should be allowed to prescribe medication for their patients, previously restricted to psychiatrists (MD)?

New Mexico First to Let Psychologists Give Meds
Thu Mar 7, 5:25 PM ET
By Alicia Ault

NEW YORK (Reuters Health) - New Mexico Governor Gary Johnson signed a bill Wednesday giving psychologists the ability to prescribe medications, but psychiatrists were vowing fight back.


"The new law is the result of a cynical, economically motivated effort by some elements of organized psychology to achieve legislated prescriptive authority without benefit of medical education and training," said Richard Harding, president of the American Psychiatric Association in a statement. "Psychology prescribing laws are bad medicine for patients," he added.

The American Psychological Association countered that letting psychologists prescribe might actually result in better patient care. The organization claimed that there was such a severe shortage of psychiatrists in New Mexico that patients were waiting 6 weeks to 5 months to see a doctor. Suicide rates for 15- to 24-year-old New Mexicans were 75% higher than the national average.

Letting psychologists see patients who desperately need medication might improve mental health services, said the Psychological Association.

The Psychiatric Association called that argument a Trojan horse, noting that the psychologists rejected proposals to limit prescribing privileges to psychologists located in under-served areas.

Under the New Mexico law, psychologists won't be allowed to start prescribing right away. Details still have to be worked out, so psychiatrists may get a say in implementation of the law.

The current plan will require psychologists to complete at least 450 hours of coursework in subjects such as neuroanatomy, clinical pharmacology, psychopharmacology and pathophysiology, and to take a 400-hour practicum where they see 100 patients under physician supervision. Psychologists then will have to pass a national certification exam.

Then, psychologists will be given a 2-year license, allowing them to prescribe under a physician's supervision. The physician has a say in whether the psychologist is allowed to become an independent prescriber after the 2-year probationary period.

The Psychological Association has been fighting for more than a decade to secure prescribing privileges for its members, who have doctoral degrees in psychology but not usually any medical training. The organization has argued that having one practitioner give a patient medication and therapy makes economic sense.

"We know from experience and research that the provision of integrated care--when it's done by one provider--has been shown to be more cost-effective than when done by two separate providers," Russ Newman, the Psychological Association's executive director for professional practice, told Reuters Health.

Newman said states may now look more closely at approving prescribing privileges for psychologists, since they would no longer be the first to do so, and because data will eventually be available from New Mexico. "How quickly that will happen, I don't know," he said.

Guam passed a prescribing law in 1999. Over the years, 14 states have rejected such legislation.

The Psychiatric Association said the laws were rejected after legislators objectively considered "the scientific data and the public health risks of placing potent medications for treatment of mental illness in the hands of people with no medical education or residency training." Psychiatrists have gone through medical school.

 

[gel1]

It may be a good idea to allow some psychologists (with PhDs) to prescribe some medications. However, I would like to see a limitation on the type of medications that can be prescribed. Depending on the patient, I think seeing a psychiatrist is preferable for going on medications that are possibly addictive (like some sleeping pills). This is in addition to taking the classes mentioned in the article. I am a bit skeptical, because the quality of the education of someone with a psychology PhD is not as tightly regulated as someone with an MD.

 

[brandonite]

Ya, I'm pretty uncomfortable with it. I mean, there are a lot of medical complications that could result from prescription medications, and it would be hard for someone without extensive training in all the areas of medicine. MD's go through two years of training in all areas of the body, spend time in clerkships studying various aspects of medicine, etc... I don't know if weekend courses can replace all of that training.

And, like someone pointed out, PhD training is not as strictly controlled as MD training. Med schools go through a VERY extensive LCME accredidation process that PhD programs do not.

I mean, I understand the situation. But I'm pretty uncomfortable with this... 😕

 

[WMN]

I know this is going to get some people really upset, but what the heck. I do not believe that psychologists should have prescribing privileges because these privileges may get mis-used. I have been a clinical pharmacist for 6 years and it scares me to see how dentists, ANP, and PA-C prescribe medications. MDs and DOs can be pretty scary too!!! In a perfect world, physcians etc should diagnose and clinical pharmacists should prescribe. Medical education does not have enough pharmacology and I believe this needs to be addressed. Other health care providers have even less pharmacology than physcians.
Here are some examples of things that I have seen - a denstist renewing a patient's zoloft prescription (an anti-depressant)
MD, DO, ANP, and PA-C prescribing Toradol and another Non-steroidal anti-inflammatory (NSAID)for patients because they did not know that Toradol was an NSAID. Again, Toradol being prescribed for patients with active peptic ulcer disease because the prescriber did not know that it was a NSAID.
Zosyn (a penicillin derivative) being ordered for patients with penicillin allergies because the prescriber did not know what class of antibiotic Zosyn belonged to.
Concomitant use of penicillin and Unasyn (ampicillin plus sulbactam) because the PA did not know what Unasyn was.Incorrect doses of medications due to the lack of knowledge of the need for dosage adjustment in renal insufficiency.
These providers are not incompetent, they simply lack the education and knowledge needed for the proper use of medications. I could take up a whole page with my experiences, but I think you all get my point. I have been accepted to medical school and will be a physcian one day - when I am out there treating patients, the first person I will get acquainted with is going to be a clinical pharmacist. Something for you all to think about.

 

[Hamster]

No. For the same reasons as those mentioned above. In addition to contraindications and Rx interactions, I just don't think a psychologist would be able to evaluate the how his prescription is affecting the entire health of his patient. A psychologist is trained as a specialist first, while at least psychiatrists have a basic science background and a generalist training and thus should know how the 'normal 70-kg man' functions. If a psychologist prescribes a drug, who would he follow-up with? his family doc? if so who pays the malpractice if things go wrong?
Man talk about a turf war! <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" /> If this materializes what incentive would MDs have to set up shop in New Mexico? Residents would begin to 'realize' the only difference between a psychiatrist and a psychologist is higher fees...and this would act to run all the MD's out of NM... I hardly believe this is an attempt by the APA to increase quality health care...but to increa$e $omething el$e :wink: I mean come on why don't they just spend their money to recruit more MD's instead of lobbying to get this passed

 

[kylie]

no, certainly not!

 

[Street Philosopher]

no

 

[Herr Doktor]

no

 

[brandonite]

•••quote:•••Originally posted by Herr Doktor:
•no•••••I don't see SMW around, so in her absence, welcome to SDN!!

 

[Yogi Bear]

bump

 

[eagle26]

Hell no.

 

[ckent]

Well, to be honest, I can't think of any reasons why psychologists should not be allowed to prescribe some psychiatric medications. They should at least be able to prescribe the SSRIs, they are probably the easiest drugs to prescribe (few interactions, no blood work necessary, relatively benign drugs). Psychiatrists don't do anything special when they are prescribing drugs, they aren't supposed to do a physical for obvious reasons, they just ask patients if they are taking any other medication and then go by the patient interview to decide what drugs might help their patient. These days it's getting even easier with computers, all you have to do is type in two different medications and you can get whether or not the drugs are contraindicated together, special dosing, etc. SSRIs, TCAs, MAOIs, and even some antipsychotics would probably be perfectly safe for psychologists to prescribe. On a side note, I think that the whole field of psychiatry should be disbanded in my opinion, the specialty is waste of a medical education. You really don't need the medical training of medical school to be a psychiatrist, and psychologists spend their training time more efficiently learning how to take care of patients right away whereas psychiatrists have to wait until residency and get a shorter training. The specialty is a magnet for doctors who are either mentally ill themselves or incompetent clinicians anyways. I'm sure that there are exceptions, but that's just my general impression of the field.

 

[none]

Do they receive the training needed to give out the medications? If so, then definitely. Physicians are trained in a wide range of pharmacology, psychologists certainly don't need to be. If their training includes psychiatric medications, then they most certainly should be allowed to prescribe them. And if you'll recall...the problem is that there is a psychiatrist shortage in NM, so you don't need to worry about running them out...they aren't there anyways.

 

[megkudos]

No.

The problem is where do you draw the line on what the would be able prescribe? Sure if it was only SSRI's then I could maybe see it being ok. But what happens when they start perscribing anti-convulsant medications which are often used for things such as biopolar disorder or controlled substances such as benzos used for anxiety disorders and even worse Narcotics such as Ritalin used for ADHD....the list could go on and on for the different types of drugs and the possibilities of having side affects. Psychiatrists spend years studying the entire body, not just the affects on the mind. In my opinion psychologists depth of knowledge is just not sufficient enough.

 

[Vader]

•••quote:•••Originally posted by ckent:
•I think that the whole field of psychiatry should be disbanded in my opinion, the specialty is waste of a medical education. You really don't need the medical training of medical school to be a psychiatrist, and psychologists spend their training time more efficiently learning how to take care of patients right away whereas psychiatrists have to wait until residency and get a shorter training. The specialty is a magnet for doctors who are either mentally ill themselves or incompetent clinicians anyways. I'm sure that there are exceptions, but that's just my general impression of the field.•••••On the contrary, the field of psychiatry has made startling advances in the last couple of decades. The realization that most (if not all) psychiatric disorders have a biological basis in the brain makes it essential that patients be treated by physicians who have a good understanding of biology, medicine, and how the brain works. Part of medical school is learning clinical reasoning skills and to develop professional skills in order to provide care for patients.

I can tell you the psychiatrists that I've met (at UCLA) are excellent clinicians, with the ability to diagnose and treat illness, while conducting research that furthers our understanding of the field and offers new hope for patients.

Both psychologists and psychiatrists play essential roles as part of the health care team. We need both to adequately address the biological and pyschosocial issues of each patient.

 

[kafka79]

If psychologists are able to presciibe drugs, will there be any need for psychiatrists?

 

[PACmatthew]

WMN,
This response is to WMN who somehow thinks that a pharmacist should be allowed to determine what medicine a patient should be prescribed. There is a reason why pharmacists cannot and will never be able to decide which medicine a patient takes. This is because pharmacists have virtually no CLINICAL knowledge or training. You can simply not know what medication is right for a patient based on your knowledge of the chemistry of the meds. Yes, in theory, pharmacists are still more highly trained than any other group when it comes to medications and their interactions, but don't kid yourself if you think pharmacists are all medication gooroos. I daily get phone calls from pharmacists asking me questions that are equally as stupid as the ones you mentioned in your post. In a perfect world, pharmacists would literally be computers that could screen meds and interactions, but in reality we already have this. You guys will all figure out soon enough that it is COMMONPLACE to write prescriptions for things that have minor interractions, because it is clinical experience that allows one to be comfortable doing such. There will never be a day when a physician writes a prescription that says "hypertension, treat". That is absolutely a dream perpetuated by pharmacists. Don't get me wrong, I like pharmacists, but lets all admit that there are plenty of pharmacists at local chain stores that aren't any more knowledgable about the medications they dispense than the physician who prescribes them.

 

[eagle26]

I agree Vader. With increased understanding of the biology of mental illness, i.e. the role of neurotransmitters, the way neural pathways are essentially "rewired" (Kindling hypothesis), I see the role of psychiatry moving to neuropsychiatry. Eventually, as we gain more understanding of the biology, I see the fields of psychiatry and neurology merging.
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[Vader]

•••quote:•••Originally posted by heelpain:
•Not only medications have a biological effect on a person's brain. Cognitive behavioral therapy often used on obsessive-compulsive and related disorders, has been shown to alter brain chemistry. Psychologists are the ones that usually do cognitive behavioral therapy.

Psychologists are also involved in researching the biological basis of behavior and emotion. For instance, many psychologists are conducting research on obsessive-compulsive disorder in relation to brain chemistry.•••••Absolutely true... there is quite an astounding interaction between behavior, environment, and the body that we are only beginning to unravel. In my experience, I have worked with psychiatrists and psychologists on collaborative projects correlating brain structure with psychiatric disorders.

There is certainly considerable overlap between the fields of psychiatry and psychology, but they approach questions about the brain from slightly different angles, both quite valid and significant. You're absolutely right about there being psychologists who study brain biochemistry (just as there are psychiatrists studying behavior and emotion). The distinction is increasingly blurring, but in general (and ONLY in general), they tackle problems using different approaches.

I like to say that we're all neuroscientists at heart... 😀