Prescriptive authority for psychologists movement
Encyclopedia
The Prescriptive authority for psychologists (RxP) movement is a public health initiative to give prescriptive authority to psychologists
with 2 years of postdoctoral Masters degreed training in clinical psychopharmacology, followed by 1 - 2 years of supervised prescribing, or a Certificate from the Department of Defense program, or the Board Certified Diplomate from the Prescribing Psychologists Register (FICPP or FICPPM), enabling them to prescribe psychotropic medications to treat mental and emotional disorders. Prior to RxP legislation and in states where it has not been passed, this role is played by psychiatrists, who possess a medical degree and thus the authority to prescribe medication, but whose numbers are at a critical shortage, and predominantly by primary care physicians, who can prescribe psychotropics but lack specific training in psychotropic drugs and completely lack training in diagnosing and treating psychological disorders. Prescribing psychologists' training in pharmacology is 2.5x more than that of average physicians and nurse practitioners combined, almost five times more than physicians alone. According to the American Psychological Association, the professional organization representing the interests of psychologists, the movement is a reaction to the growing public need for mental health services, particularly in less urbanized and therefore under-resourced areas where patients have little or no access to psychiatrists.
Currently, in states where RxP legislation has been passed, psychologists who seek prescriptive authority must possess a doctoral level degree (PhD
/PsyD/EdD) and a license to practice independently, with five years of clinical experience working with patients as a health care provider, and undergo a post-doctoral Master of Science degree education and training or any of the previous training programs from the Department of Defense or Prescribing Psychologist Register prior to the inception of the postdoctoral Masters. The basic science and medical phase of the post-doctoral Master of Science in Clinical Psychopharmacology degree may be completed with an on-line degree program free of patient interaction, followed by two years of supervised work experience working directly with and prescribing for 100 patients under a physician's or psychiatrist's supervision, making it a total of 4 years of training, the same number of years it takes to go to medical school. The medications they may prescribe are limited to those indicated for mental and emotional health problems; the specific list of approved medications differs by state. The psychologist usually collaborates with a physician on treatment.
became the first U.S. territory to approve RxP legislation in 1999. New Mexico
became the first state to approve RxP legislation in 2002, and Louisiana
followed in 2004. As of April 2007, 5 other states have introduced RxP bills that are under discussion but have yet to be approved. In 2009, psychologists with prescriptive authority in Louisiana had the regulation of their practice of medical psychology and psychology transferred to the Louisiana State Board of Medical Examiners. Louisiana is the only state in the U.S. where a medical board has authority over the regulation of the entire practice of psychology (for medical psychologists).
Additionally, critics express concern that, if RxP became the norm, the biomedical approach would begin to encroach on the traditional psychology curriculum and clinicians in training would receive less grounding in psychotherapeutic interventions and research.
Psychologist
Psychologist is a professional or academic title used by individuals who are either:* Clinical professionals who work with patients in a variety of therapeutic contexts .* Scientists conducting psychological research or teaching psychology in a college...
with 2 years of postdoctoral Masters degreed training in clinical psychopharmacology, followed by 1 - 2 years of supervised prescribing, or a Certificate from the Department of Defense program, or the Board Certified Diplomate from the Prescribing Psychologists Register (FICPP or FICPPM), enabling them to prescribe psychotropic medications to treat mental and emotional disorders. Prior to RxP legislation and in states where it has not been passed, this role is played by psychiatrists, who possess a medical degree and thus the authority to prescribe medication, but whose numbers are at a critical shortage, and predominantly by primary care physicians, who can prescribe psychotropics but lack specific training in psychotropic drugs and completely lack training in diagnosing and treating psychological disorders. Prescribing psychologists' training in pharmacology is 2.5x more than that of average physicians and nurse practitioners combined, almost five times more than physicians alone. According to the American Psychological Association, the professional organization representing the interests of psychologists, the movement is a reaction to the growing public need for mental health services, particularly in less urbanized and therefore under-resourced areas where patients have little or no access to psychiatrists.
Currently, in states where RxP legislation has been passed, psychologists who seek prescriptive authority must possess a doctoral level degree (PhD
PHD
PHD may refer to:*Ph.D., a doctorate of philosophy*Ph.D. , a 1980s British group*PHD finger, a protein sequence*PHD Mountain Software, an outdoor clothing and equipment company*PhD Docbook renderer, an XML renderer...
/PsyD/EdD) and a license to practice independently, with five years of clinical experience working with patients as a health care provider, and undergo a post-doctoral Master of Science degree education and training or any of the previous training programs from the Department of Defense or Prescribing Psychologist Register prior to the inception of the postdoctoral Masters. The basic science and medical phase of the post-doctoral Master of Science in Clinical Psychopharmacology degree may be completed with an on-line degree program free of patient interaction, followed by two years of supervised work experience working directly with and prescribing for 100 patients under a physician's or psychiatrist's supervision, making it a total of 4 years of training, the same number of years it takes to go to medical school. The medications they may prescribe are limited to those indicated for mental and emotional health problems; the specific list of approved medications differs by state. The psychologist usually collaborates with a physician on treatment.
History
In 1988, the U.S. Department of Defense approved a pilot project to train psychologists in issuing psychotropic medications "under certain circumstances". GuamGuam
Guam is an organized, unincorporated territory of the United States located in the western Pacific Ocean. It is one of five U.S. territories with an established civilian government. Guam is listed as one of 16 Non-Self-Governing Territories by the Special Committee on Decolonization of the United...
became the first U.S. territory to approve RxP legislation in 1999. New Mexico
New Mexico
New Mexico is a state located in the southwest and western regions of the United States. New Mexico is also usually considered one of the Mountain States. With a population density of 16 per square mile, New Mexico is the sixth-most sparsely inhabited U.S...
became the first state to approve RxP legislation in 2002, and Louisiana
Louisiana
Louisiana is a state located in the southern region of the United States of America. Its capital is Baton Rouge and largest city is New Orleans. Louisiana is the only state in the U.S. with political subdivisions termed parishes, which are local governments equivalent to counties...
followed in 2004. As of April 2007, 5 other states have introduced RxP bills that are under discussion but have yet to be approved. In 2009, psychologists with prescriptive authority in Louisiana had the regulation of their practice of medical psychology and psychology transferred to the Louisiana State Board of Medical Examiners. Louisiana is the only state in the U.S. where a medical board has authority over the regulation of the entire practice of psychology (for medical psychologists).
Supporting arguments
There are several core arguments put forth by RxP advocates, including the following:- Other non-physicians have prescription privileges, such as optometrists, nurse practitioners, physician's assistants, and pharmacists, all of which with the exception of pharmacists, receive less training in clinical pharmacology, therapeutics, and psychopharmacology.
- The training model is supported by a complete lack of legal complaint after eight years regarding the practice of the initial ten psychologists trained by the U.S. Department of DefenseUnited States Department of DefenseThe United States Department of Defense is the U.S...
. Legal complaints differ from legal suits, as military personnel cannot sue for redress. - Access to medication would be immediate as opposed to long waiting times that are sometimes necessary to see a qualified psychiatrist.
- It would not come at the expense of adequate training in the science of psychology, assessment, or psychotherapy because such education would be post-doctoral and more extensive than the average physician, and twice as much pharmacology training than nurse practitioners and physician assistants receive who still cannot diagnose psychiatric disorders.
- It would address the fact that many lack access to psychiatrists (especially in rural areas).
- It would make a more distinct separation between doctoral and masters-level practitioners, and between doctoral and post-doctoral level practitioners.
- It would allow the psychologist control of the entire treatment process, which would avoid the complications of interprofessional collaboration while also saving clients money.
- Adding competence to consult with general practitioners who need professional advice regarding psychotropic medications when a proper psychiatrist is unavailable.
- Psychopharmaceutical training allows for better client advocacy.
Opposition
- Prescriptive authority, when sought by other non-physicians such as nurses, was also controversial to physicians and within their professions even though their training was already medical in nature. The medical community has always fought granting prescriptive authority to other types of degreed trained professionals and eventually lost (NPs, PAs, podiatrists, etc).
- Many of the allied health professions Ex. Pharmacists do not teach basic principles of internal medicine, they key in successful diagnosis, which is one of the reasons prescription writing is argued.
Additionally, critics express concern that, if RxP became the norm, the biomedical approach would begin to encroach on the traditional psychology curriculum and clinicians in training would receive less grounding in psychotherapeutic interventions and research.