This story caught my eye only because of its headline, Psychologists seek authority to prescribe psychotropic medications. Really? I thought… I never heard that before.
Oh, wait a minute, I have. Because the last time I checked, psychologists have been seeking prescription privileges for something like 16 or 17 years, maybe longer. In all of that time, they’ve only gained them in two states.
Was another state joining New Mexico and Louisiana? Was there a renewed push for this service because of a sudden demand for prescriptions from those who have a mental illness?
In other words, for this new article that appeared in the Washington Post (but was actually written by the Kaiser Family Foundation, a healthcare policy organization) — what’s newsworthy about this story?
After reading through the story twice, I couldn’t find a single thing.
In any story about psychologists wanting to expand their professional scope to suddenly include the practice of medicine, you can bet on a few things the author has to be sure to include:
- The “successes” psychologists have had with gaining prescription privileges in 2 states (often with no context for how many times psychologists have tried in other states, but failed)
- A spokesperson for the American Psychological Association noting how this is an “access” issue (but with no actual scientific data to back up the assertion; instead anecdotal data is used)
- A note about the widespread prevalence of mental illness rates in America, to make it appear that there’s huge pent-up demand for services (simply untrue)
- No serious analysis of the logical fallacy conducted that leaves otherwise thoughtful professionals to conclude that psychologists would never succumb to the same market pressures that pushed psychiatry out of psychotherapy and primarily into writing prescriptions (e.g., it pays better to write more prescriptions than it does to conduct psychotherapy)
- The obligatory objection statement, usually coming from a spokesperson from a psychiatry group, the AMA, or, in this case, NAMI
- No actual update on where exactly the psychologists are this year in the battle to win prescription privileges in more states, other than noting it is “winding its way through” a half dozen state legislatures (again, with no mention this happens every year and every year it is rejected)
As you probably know, I reject the argument that psychologists need a special law passed in each state to suggest their professional training makes them a unique class of citizens that can undergo a specialized training program for prescribing psychiatric medications. Psychologists have always had multiple routes open to them to gain prescription privileges — get an MD, or become a physician’s assistant or some other health care professional who has limited prescribing privileges.
Psych Central is against this ridiculous attempt of psychologists to expand their scope of practice into areas that they simply were not trained to do. Being experts in human behavior doesn’t mean you’re a good professional to be understanding the complex interactions that psychiatric medications have with dozens of different non-psychiatric medications and hundreds of medical conditions. That’s why we have physicians.
If there are too few psychiatrists, the solution is far simpler and less expensive — create whatever incentive is necessary to encourage more new doctors to specialize in psychiatry. The solution is not for one profession to try and impinge on another profession’s area of expertise and services.
Read the article: Psychologists seek authority to prescribe psychotropic medications
34 comments
That’s a terrific summary of this ongoing non-story story. I did want to point out, though, that it’s not “psychologists,” it’s a subset of that group.
In the past when this has come up, I have asked the psychologists I know if they would be interested in prescribing were that to become legally possible. To a person they have said something along the lines of, “No way!” I’m an LCSW, so outside this particular fray, but I did want to speak up on behalf of the psychologists I know who agree that this particular turf battle is a bad idea.
Yeah they can prescribe meds when they become a real doctor and have a MD.
Bravo! The most sensible thing I have seen on this topic and I am in compllete agreement. Thank you so much for saying it so well.
Excellent points. Thank you Dr. Grohol for pointing out the problems of having psychologists prescribe and the fallacious and illogical arguments used by proponents of psychologist prescribing. Short cuts to prescribing, such as those advocated by the American Psychological Association’s traing model for psychologists to prescribe, are not a pathway to providing quality care and are not in patients’ best interests.
John, I strongly agree with you that RxP is a bad goal for APA to pursue. But my reasons are different than yours: 1. The use of psychiatric prescriptions is supported by flawed studies–it’s well established that the patients in so-called double-blind studies can often tell when they are getting the placebo. 2–the studies are funded by drug companies who have been shown to suppress publication of results they don’t like. 3–Plenty of research has found psychotherapy as good as or better than medication for many patients. We are better equipped to provide psychotherapy than other mental health professionals, but you can bet that managed care will reduce our already low “allowed fees” to the pittance they are currently paying counselors and social workers for doing psychotherapy, while welcoming the chance to pay RxP-trained psychologists less for Rx management than they are currently paying psychiatrists. As a result, there will be a shortage of psychologists providing psychotherapy.
I enjoyed the article and I agree with Dr. Barach. Take a closer look behind the economics of what is driving this push for prescribing privilege and you find it is the pharmaceutical industry in particular and a sickness management industry in general. It is just another way to expand their market. Cui bono? It isn’t psychology as a discipline, it isn’t our patients, and it isn’t our overall public health. Psychotherapy is becoming a lost art, and yet long term outcome studies consistently show it is our patients’ best hope for healthy, happy, and productive lives. It concerns me how many scientifically trained psychologists fail to critically think about the “research” they see in journals and the bias inherent in our flawed regulatory and oversight systems. So much of what we think we are learning is tremendously distorted. But the siren song is still luring ships closer to the shore, and psychology is lining up to drink the same Kool-Aid psychiatry did 50 years ago. Those who don’t know their history are doomed to repeat it. Unfortunately, our overall public health continues to suffer and many of us in psychology continue to compliment the Emperor on his New Clothes and hope that one day we could be as well dressed.
The real issue is the lack of governance, rigor and training on who can be trained as and called a “psychologist.” Sorry, but coming out of a strong Clinical PhD program and pre-doc fellowship, I know a lot more about Neurology, Brain Physiology/Chemistry and Behavior than the Family Practice/Pediatricians/Nonspecialists residents I training who are today doling out psychostimulants and antidepressants like it’s candy.
20+ years ago it was actually more difficult to get into a PhD program in Clinical Psychology than it was medical school. Now it has become a business and any rigorous standards for admission have been diluted. How many PsyD and PhD revenue generating programs have cropped up over the last 30 years just so some working professional can call themselves “Dr.”, hang a shingle outside and preach their version of life gospel from the soft chair.
Beyond the complexity of neurobiology and neuroanatomy, the “art” of psychiatry (as it was referred to by a med school psychiatrist) comes down to a Kaplan’s Law of “hit it harder or softer.”
The research is pretty clear that we know psychopharmacology is an effective additional tool. Who better to administrate it judiciously, ethically and effectively than an expert in overall behavior who has the competency to see pharmacological interventions outside a narrow biological paradigm.
Oh wait, I forgot that with the literally thousands of “psychologists” we’ve diploma milled out there, we really don’t have that edge of behavioral expertise anymore.
The article kind of looses credibility when the arguments lack their own empirical support. For example, the author makes the point, “A spokesperson for the American Psychological Association noting how this is an “access†issue (but with no actual scientific data to back up the assertion; instead anecdotal data is used)”. This is not true and a very simple search on New Mexico and Louisiana’s legislative history of prescriptive rights shows that in their areas, they felt there were access issues.
Also, point one doesn’t provide credibility to the argument. All it demonstrates is that there has been a long history of legislatives pushes, but it doesn’t prove or disprove whether prescriptive rights are beneficial or not.
It is a little disappointing to read a lot of conjecture amounting to “they say this, but its not true”, without providing supportive evidence.
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“They felt there were access issues” isn’t empirical support, FYI.
Show me the data, and then show me that there weren’t other ways to incentivize more medical students to choose psychiatry as their specialty area that would ultimately be more cost effective and address the access issues in a far more timely and appropriate manner.
Even if true, all this argues for is that psychologists should be allowed limited prescription rights in poor and rural areas in the U.S. where access issues can be empirically demonstrated, and that other specialty areas — such as psychiatric nurses — can’t fulfill.
One big issue is the sharp drop in medical student applications in the last few years. IF that drop continues how do you hope to draw more people in to medical schools for psychiatry.
What a frankly silly statement – that people should be “incentivized” to choose psychiatry. Specialties are determined by both interest and – wait for it – the market. If there is a shortage of prescribers THAT is the incentive, simple economics. After that, it’s not about psychiatrists or psychologists or pmh-np’s per se, it’s about whoever’s lobby has the most money – it’s not hardly about sound medicine, as it should be – and a properly supplementary trained psychologist would be just as qualified as any similarly trained professional. I agree with the sole dissenter, you are unable to see it – but your argument is wholly invalid and pointless. You could have simply said, “I’m against psychologist Rx privileges.”
You mention economics, but it is actually that what makes psychiatrist not let go of the priviledge. Is just the fear of losing a very profitable market. It has nothing to do with quality of care, otherwise they would not allow psychiatrist to perform diagnostic evaluations in 15 minutes. That is dangrous.
Why do people keep placing the full responsibility of producing more trained licensed psychiatrists on the medical school?
Why can’t there be another concentration in addition to neuropsychology that qualifying curricula is jointly determine by a university’s medical school, neuroscience, & psychology doctorate programs?
In response to this (counter argument, to the author’s quote above): “Show me the data, and then show me that there weren’t other ways to incentivize more medical students to choose psychiatry as their specialty area that would ultimately be more cost effective and address the access issues in a far more timely and appropriate manner…” (I am a psychologist, so I am biased of course), but I personally just don’t buy it attitude. Repeatedly I see the counter argument in this blog asking how or why would paying for (someone has to do it) more psychiatrists be cheaper? How? No one wants to responds to this counter argument or asking for further information. The DOD found that Rx Psy Docs were expensive because they footed the bill. One thing I’ve learned about economics is supply and demand of course — psychologistd wanting rx would pay up, they would not have not be incentivized so to speak, so how is paying for more psychiatrists cheaper? No one has directly response to that (and making psychologists pursue PA degrees, NP or MD is definitely not). Moving forward… Rx psychologists won’t be well trained enough for rx… this argument either – I don’t buy it. I think if someone looks at the facts and looks at it logically, rx psych docs not being well trained is just a poor argument (why can’t we have a realistic debate on this issues). I could also say (to play devil’s advocate that realistically, psychiatrists shouldn’t be prescribing psychotropic meds because that should be a neurologists’ lane – due to the complicated and still not fully understood nature of many of these meds and their off label uses and their impact on the brain (not that rx psych docs need to get into aggressive poly pharm approaches either)—and look if you went to see a GP for a knee injury and he started to operate, he would be outside if his scope of practice, rx psych docs have a similar concept in mind– not fair to stay we can’t get rx priv without the whole FDA formulary or there is no wsy without a 4 year MD we could possibly or effectively prescribe (if really believe this then the PCM concept should basically be eliminated and only specialty care be pursued – this is not possible for very practical reasons) . I currently work (as a psychologist) at a DOD army hospital and there is one psychologist licensed there to prescribe meds who works in primary care (in most federal institutions, it does not matter what state you are licensed in– i.e. that is the case of this prescribing psychologist I am speaking of; he is licensed in a state that allows it, but is able to work at this federal institution in another state). Anyway, point is the primary care docs, etc. love this person as he has vast knowledge on both the best mental health treatments and psycho pharm (the MDs/ NPs in this primary care setting routinely turn to him for advice regarding what pills to prescribe). He has a long waiting list for patients… I don’t know, proof is in the pudding… right? The only resistance came several years ago when psychiatry tried to block the credentialing which didn’t work (a little worried psychiatry, huh?)… Also, in terms of psychiatrists there about 10 to the 50 psychologists at this hospital. I am not turning this into some sort of psychiatry vs. psychology debate for the 100th time—but many NPs, PAs, and GPs turn to the psychologists for help with behavioral health treatment. Psychiatry is dying (I am seeing it first hand), psychologists will have to get prescription privileges eventually—it’s only a matter of time! Also, as the individuals who support this, like to say it has worked and (rx for psych docs) and continues to work—someone please address this realistically—that this is the best argument, but come on, I have yet to read anyone effectively refuting this point so far?
I am in 100% support of the legislation that allows psychologists to prescribe medication. There are already prescribing psychologists in parts of our country who are providing wonderful service. This legislation only seeks to expand the opportunities so that more patients-in-need receive care. This legislation is not a threat to psychiatry and is not a threat to patient care. It is the right thing to do and I applaud the efforts of the individuals involved who are taking bold action to ensure that this legislation passes.
I am in 100% support of psychologists prescribing medication. There are already many prescribing psychologists in parts of our nation who are providing wonderful services to patients in need. This legislation only seeks to expand the opportunities so more patients can receive help. This legislation is not a threat to psychiatry or to patient safety. I applaud the efforts of those professionals who are working hard to ensure that this legislation passes.
Instead of increasing the number of psychiatrist, why don’t we decrease the number of psychologists by making the entrance and degree requirements more stringent? Psychology is unable to clearly articulate itself and its benefits over non-psychology mental health providers. Bottom line is that the profession is simply not respected as science by the greater lay population and will not garner support.
The APA has only served to further dilute the profession by accrediting just about every training entity that calls itself a psychology training program. What has the APA really done in regards to psychology advocacy over the past 30 years? It, like psychology, is mired in its old ways and is becoming less and less relevant to the general public.
The Psychology PhD could just as well be a 3 year post-bachelors degree akin to a law degree to better level-set the educational investment in-line with the occupational roles, responsibilities and opportunities.
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James — Aren’t entrance and degree requirements for a degree set by the individual colleges and universities? How would you enforce universities — both public and private — to adhere to whatever arbitrary guidelines you set?
After all, psychology is not a single profession regulated by a single agency in the country. It is a very diverse profession, with many, many sub-specialties and career paths.
And by the same token, how would you – in some central planning fashion – “incentivize” MD students into psychiatry. You suggest what you turn around and criticize that writer for.
Well, with proper training why wouldn’t psychologist be able to prescribe medications? Nurse practitioners do it, in some states PAs do it, family practitioners (who prescribe 80% of all psychotropic drugs, but who only did a 6 week psychiatry rotation in med school, do it; dentists do it-prescribe powerful pain-killers, etc…). This seems more like a political issue than substantive one? (is psychiatry trully medical discipline? Is there a blood test for bipolar disorder?)
Gee, I don’t know, maybe learning about the role of pharmacology while equally learning about physiology, pathology, and drug-drug interactions outside psychotropics might make one realize that prescribing a pill is not a simple and easily applicable intervention.
How about this as an equivalent: why not let social workers do psychological testing? Bet a lot of psychologists are behind that idea, eh?
Soon all you’ll need is a Bachelor’s degree, hell, why not just an associates degree to provide psychotherapy. Believe the lie enough and it becomes truth. Hey, if mental health care is so easy, why isn’t the incidence of mental health illnesses declining in this country? I guess the pills don’t treat all ills, you think!?
I would love to see limited prescription privileges for psychotropics; but not to just psychologists! I have, in addition to my MSW an MA in Psychology. I had been premed prior to both Masters, and I started back in school over a year ago to work towards a nursing degree to become a Nurse Practicioner to have the ability to write scripts. In my area there is a shortage of psychopharmacologists, especially with children (as there is nationally). Patients have difficulty finding psychiatrists on their insurances, even if the patients are adults. It is harder when clients have autistic spectrum disorders, an eating disorder or other special need. I went back to school after two Masters to fill that need. I’ve taken all the prerequisites for med school and BSN programs. I believe that anyone who wishes to prescribe should have a strong science background and have to take at a minimum bio, chem, A&P, pathophysiology, microbiology and other courses that would be necessary in order to know the effects of medications on systems, prevent interactions between medications and avoid complications. Dr. Hassman, shame on you, not all social workers are created equally- how about making conclusions on what training a person has despite their degree as opposed to painting with a broad brush and sarcasm that is both unprofessional and insulting. As I’m sure you have- I have found MD’s, psychologists and social workers that are good, and many that I would not wish to refer anyone to. Rather than provide blanket abilities to a whole profession how about having a minimum requirement of courses that a mental health professional (Masters/Doctorate) would need to have to have privileges. Perhaps the sciences necessary for a NP without the “frills”. Could write more but am on my way out of work. Good topic!
ok, I understand what you are saying, so now we need to look at the other side of the case, psychiatrists no longer conduct therapy yet, they are prescribing life altering (yes, life) medications based on a 15 minute conversation. (yes, I have seen this happen) If you are a patient in treatment, would you not prefer that someone who knows you, your issues etc. prescribe you a med. and be better able to judge and monitor side effects, than someone who see’s you 1x a month for 15 minutes maximum?
I agree with Brenda, but even worse is that 90% of all psychiatric drugs are Rx by general practitioners, not psychiatrists. GPs have very little training in psychiatry, and every 2-3 month monitoring is not nearly enough. The new programs for psychologists to obtain RxP is exactly what “they need”…the medical training to Rx. They will not be PAs or MDs. The legislation written/proposed limits the psychologist from becoming like the psychiatrists (aka puppets of drug companies) by stating they can not Rx to a patient without doing psychotherapy with them, can not have the majority of their income from Rx, can not take ANY money or incentives from drug companies or other “nonprofit” resources, etc… The NAPPP who supports the RxP has taken every step they can think of to ensure the field of psychology does not become corrupt like psychiatry/medicine. It has reached an epidemic, and people need people well trained on psychiatric drugs to help them get off psychiatric drugs. Allowing a psychologist the Rx pad, allows them to say no to the Rx pad…whereas, as it stands now, psychologists get a patient on Rxs and can’t get them off sometimes because the MD/PA/Psychiatrist doesn’t want the liability, doesn’t know how to, sees it as a biological life long disease, and does not want to lose the income. The psychologist will still see the patient (no loss of income), understands the Rx is a short term-temporary crutch, knows it is not a “disease”, and will know specifically how to help someone titrate down and or off medications if they elect to do so.
I think it is quite weird that their was zero talk about how the majority of all psychoactive medicine is prescribed by doctors not psychologists. Most using only basic assessments that they have little or no training to use. This is a big factor that was never discussed. Also no one is saying that we give psychologists prescription privilege, most if not all agree their should be required courses. Pharma class for med school last on average 1 year. why force a psychologist to go to med school for something they most certainly can learn in the same amount of course work.
It is my understanding that the states that permit psychologist prescribing privileges have required them to complete the extra training. Food for thought
1. Most psychology doctorate programs require a course in psychopharnacology.
2. Most psychs seeking Rx authority in states that grant psychologists that opportunity require more medical training, they must complete both written & oral examinations with a certain score (in LA it’s in front of the state medical licensing board), they must also complete a years hospital rotation. If they want to put themselves through all that work just to make about $5000, which after taxes & malpractice insurance is more like $500 more a year then they’d already be making, then they deserve it! They’re either really dumb for not doing the math head of time or they are serving a particular clientele who are highly susceptible to psychosomatic interactions & issues.
I know I’d want to have good Medical Training if I have a depressed client seeking therapy to help them move on from their lost relationship, especially if they don’t disclose that they have temporary cardiac arrhythmia due to broken heart syndrome. Patients are awesome like that about full & cross-field disclosure. They’d probably think they were having a heart attack when in reality it was just their elevated emotional stress level irritating their heart. I know if that ever happened to me, I’d want some sort of medical training so I would know exactly what to do & didn’t have a real heart attack! Additionally a medical psychologist would probably catch it at their intake physical examination.
Mr.Grohol is really missing the point that a PsyD with prescriptive authority won’t be performing full medical jobs but just provides them with the training using another set of tools for monitoring patient progress & tailoring therapy to their needs. Pharmacologically assisted therapy could also be more widely used to produce faster & better results then the other more traditional therapies.
What ever happened to just helping people in need? Everything has become all about money and recognition. We study the field to help others, not profit from their misfortunes. So I suggest putting to rest your argument that psychologists aren’t “trained” enough to prescribe and psychiatrists are superior and put your time and knowledge to better use by doing something useful like finding a way to bring the two fields together to better serve your fellow human!
I think this article is ridiculous! I believe that psychologists are real doctors and are very capable of prescribing. There have been plenty of MDs who have prescribed medications and made life threatening errors. I think what you are mainly worried about is loosing patients and as a result loosing money.
Trust me, allowing psychologists to pursue prescription privileges is not going to open Pandora’s box. Many psychologists are not bright enough in the area of medicine to pass the courses, much less the national exam, especially the Psy.D’s I’ve come across. No offense to you, Dr. Grohol. You, Dr. Grohol, may not have the capacity to prescribe, but there are psychologists that do (maybe 5% of us), and it’s not realistic to tell them to throw 7 years of graduate school and training for the PhD, to completly start over with another 7 to 10 years for an MD.
BTW, I’ve worked closely with many psychiatry residents and there is a reason why they’re considered the dregs of medicine. Don’t hold lthe cream of the crop of psychology back from truly using their talents to help people in a holistic manner because you are afraid you’ll lose your identity.
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There is nothing special nor unique about a doctoral degree in psychology that provides special understanding of medicine or medical issues that suggests they should be able to short-cut medical school in order to prescribe. There is zero research to suggest that a PhD or PsyD somehow prepares you for that course.
If you want to prescribe, take a career path as a nurse or physician that gets you that privilege. Don’t complain that just because you learned how to do psychotherapy, you should also be able to do psychiatric prescriptions.
In an ideal world, there’d be a program or degree that gets you the best of both worlds — a medical degree that allows prescribing, but is focused the entire 7 years on understanding psychology, psychological concepts, a firm grounding in research, and medicine. Too bad such a degree has been tried before and failed. Maybe it’s time to try again…
Maybe your PsyD did not require neuroanatomy, pharmacology, psychobiology, health psychology, etc., but my PhD program certainly did. I’m not saying that would suffice, but it would be very easy to provide the additional training necessary to prescribe.
Where I unfortunately would agree with you is that the APA (whom I will never give another penny) has effectively sold itself out by accrediting a variety of substandard “professional” schools and programs. Psychology is no longer a discipline of rigor because the bar has dropped so low for entry and completion of doctoral psychology degrees to anyone that wants to “help people” or call themselves a “doctor”. It’s become about as rigorous as life or executive coaching certifications who are effectively doing the same thing whether they call it psychology or not.
A non-psychiatrist medical professional (most of who prescribe psych meds – check the research) might have the medical background but also have all of about 8 weeks on a behavioral rotation. They effectively have minimal training in behavior and or psychology beyond undergrad. Treating a self-reported symptom with medicine is hardly good psychiatry. There is a lot about the medical training atmosphere that needs to be demystified. A nurse practitioner has about 2 years post bachelor’s and many PNP programs are completed online. That’s certainly a medical school equivalent.
The APA is clearly more interested in sustaining revenue to publish garbage like “treating road rage” and other useless pop psychology tripe. When an unlicensed Dr. Phil is what’s likely most associated with psychology, you gotta know the profession is in deep trouble.
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Wow, nice dig there at a fellow doctoral colleague.
Perhaps that sort of elite attitude is one of the reasons lawmakers are reluctant to view psychologists as anything more than what they are — good researchers & good clinicians.
If you want to become a prescriber, take one of the half dozen already-existing paths open to you. I suspect you’ll find that something like 90%+ of your PhD learning will be of little use to you on one of those paths.
It’s no accident that the only states where psychologists gain prescription privileges are ones where there is a chronic shortage of psychiatrists or other medical prescribers. In other words, psychologists aren’t winning prescription privileges because of their strong argument — they’re winning them out of desperation to right a market imbalance in their local community.
This article did not age well…
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