Psychologists have traditionally not been allowed to prescribe medications for their patients, but some argue that giving them this right would be better for patients, and is also vital to the future of the profession.
After a nearly 30-year push from psychologists, just two states, New Mexico and Louisiana, have passed bills allowing psychologists who complete additional education to prescribe. Last year, six states (Arizona, Hawaii, Montana, New Jersey, Oregon and Tennessee), were considering similar bills.
Unlike psychiatrists, who can prescribe drugs, psychologists do not have degrees in medicine, and opponents argue that this makes them unqualified to prescribe powerful medications. But there are not enough psychiatrists to go around, and some say psychologists could make up for this dearth, and improve patients' access to care.
Now, psychologists say they fear that the movement to integrate health care services could leave psychologists out of mental health care.
New health care legislation "is specifically focused on getting teams of doctors to work together," said Stephen Ragusea, a clinical psychologist in Key West, Fla. "In order for psychologists to fit into that model, we need to know more about psychoactive medications, and how to integrate psychology with overall medical care," Ragusea said.
Ragusea noted that other health care professionals without M.D. degrees, such as nurse practitioners and physician assistants, have prescribing rights. "I have some concerns that psychologists may be replaced with those people, if we cannot prove our value to society overall," Ragusea said.
In 2002, New Mexico became the first state to allow psychologists to prescribe, followed by Louisiana in 2004. In both states, psychologists must earn a master's degree in psychopharmacology, which is the study of how psychiatric drugs act on the body, and then must work for one year under supervision.
Psychologists in the military can also prescribe medications if they complete the appropriate training.
Elaine LeVine, of Las Cruces, N.M., said she became a prescribing psychologist because she wanted to understand the effects of the medications her patients were using.
Many of her patients say they prefer seeing one person for both their talk therapy and medications, she said.
In addition, she often uses her prescribing privileges to take people off medications who have been put on them unnecessarily, a problem she runs into particularly with child patients. "The right to prescribe is also the right to un-prescribe," LeVine said.
Before the New Mexico bill was passed, there were about 100 psychiatrists in the state, LeVine said. In the last 10 years, about 30 psychologists have completed the education to prescribe, a number of whom live in small towns. "You can see it really has increased access to care," LeVine said.
About 70 psychologists in Louisiana can prescribe, and 100 in the military, LeVine said.
Many more psychologists have completed the training, but their states have yet to pass laws giving them prescribing rights, Ragusea said.
Others argue that psychologists do not know enough about the human body or medical diagnoses to be able to prescribe psychiatric drugs.
By the time psychiatrists have completed medical school and a four-year residency, they have logged more than 10,000 hours of training, said Dr. Lisa Rone, an assistant professor of clinical psychiatry at Northwestern University Feinberg School of Medicine. In contrast, prescribing psychologists receive about 450 hours of psychopharmacology training, Rone said.
"We do not feel that this qualifies them for safely prescribing medication," she said.
In addition, psychologists have little, if any, experience diagnosing illnesses such as epilepsy and cancer that can produce psychiatric symptoms, said Dr. Jeremy Lazarus, president of the American Medical Association.
"The privilege of prescribing these powerful medications requires such intensive training and education because the stakes are so high," Lazarus said in a statement.
Psychologists counter that, in the 10 years they have been prescribing, there has not been one complaint to state licensing boards or word of a negative incident, Ragusea said.
And a review of prescribing psychologists in the military found that, while psychiatrists involved in the training initially had reservations about the idea, many rated the care of the prescribing psychologists as good to excellent, according to a report from the National Alliance on Mental Illness (NAMI).
Impact of laws
Michael Fitzpatrick, executive director at NAMI, said the first steps to improve patient care should be to provide better psychopharmacology training to general practitioners, and then to train more nurse practitioners and physician's assistants to prescribe.
"Jumping immediately to giving prescribing rights to psychologists… doesn’t make sense to us," Fitzpatrick said. For prescribing drugs, "our comfort level is higher with people who are trained in medicine," Fitzpatrick said. NAMI receives much of it's funding from pharmaceutical companies.
The real impact of the laws in New Mexico and Louisiana are not yet known, and should be studied before more laws are passed, Fitzpatrick said.
If psychologists do get the right to prescribe in all states, it will likely be a long way off, said Ragusea, who noted it took many years for psychologists to be able to earn the right to practice independently.
"Medicine is extremely protective of its turf," Ragusea said.
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