1-800-IDEA-MAN: prescribing rights for psychologists

June 9, 2007 at 10:53 pm (1-800-IDEA-MAN)

One of the more exciting trends of extending medical privilege to mid-level providers is that of granting prescribing rights to psychologists. While this idea is not originally mine, I’ll jump on as a fan and claim that licensed psychologist should be allowed to pursue a two-year post-doctoral certification program to obtain prescription rights. Similar to a PA’s training, this new program will require 1 year of classroom work and a year of clinical rotations, with an emphasis on psychiatric experiences.

Two states already have similar programs where Ph.D.’s can spend time learning pharmacology and can then receive a medical license to work under a psychiatrist. With the national shortage of shrinks, particularly pediatric psychiatrists, I would have thought physicians would be eager to have some help in providing medical therapy to mental health patients. Unfortunately, many doctors are against the idea of allowing psychologists to practice medicine.

Some psychiatrists throw out arguments such as “their training isn’t as extensive as ours” or “they wouldn’t be equipped to handle co-morbid conditions.” These points are certainly valid, but we already grant PA’s the right to practice restricted medicine with only two years of training; why shouldn’t we open the doors to others?

Certainly psychologists would not be equipped to work on a patient’s other medical issues, nor should they care for floridly psychotic patients. However, I see no reason that why a psychologist couldn’t write a prescription for Prozac as part of a therapy program. You don’t need 8 years of training to know that SSRI’s are an effective method of treating depression, and you certainly don’t need all of the years of experience to know the adverse effects that can come with giving a mind-altering medication.

The bad news is that psychologists haven’t been on their best behavior. They point out that most psych prescriptions are written by primary care docs, not psychiatrists. Some of the arguments that the psychology crowd throws out include “most MD’s only have six weeks of psychiatry training. Therefore, they are not qualified to fully work with mental health patients, either.” Don’t think that MD’s have only six weeks of training and then they’re done. After two years of basic science to learn how the body would respond to those medications, physicians have lots of training in internal medicine to learn more about clinical aspects of neuropharmacology. The “six weeks” is a time period thrown around to minimize physician training and to try to make grad school in psychology seem more robust than it really is. I’ve heard similar arguments about the length of the pharmacology courses in medical school. True, my pharm class only lasted for a month, but I can guarantee that I’ve been learning drugs for a lot longer than that.

I would love to see other states follow the model led by Louisiana and New Mexico. With adequate pharmacology training, psychologists can make a valuable impact on medical mental health.



  1. REO SpeedDealer said,

    Dude, you are being idealistic and naive. Good qualities in a medical student, but terrible once you get on the outside. Do you want to put in all this work only to get out and make an hourly wage working for wal-mart? Seriously, the invasion of the mid-level providers is killing doctors. Yes, I said it, doctors. Nobody likes that word anymore. This whole bullshit about calling everybody and their brother a “provider” is just a way for people to convince the public that a PA or NP is just as valuable as a DOCTOR. This shit pisses me off. Take a look at the lobby from independent or semi-independent providers. Give rural states like NM and LA a few years and their mid-level providers will be practicing truly independently with state sanctioning. Once one state falls, the rest will be lined up like dominoes. Now, talk to me about the opportunity cost of attending medical school to become a doctor.

  2. halfmd said,

    The moment you can show me a psychiatrist in Louisiana or New Mexico who is losing patients and income, I’ll change my opinion. I admire that you’re at least willing to admit to wanting protectionist laws to keep physician salaries high. That’s better than the people who say, “We need to protect the patients.” Doctors created the physician assistant track because they knew that there weren’t enough physicians to go around. What’s worse is that the growth of the U.S. population has outpaced the rate of MD graduations. Mid-level providers do a good job of taking care of the easy problems, leaving the doctor-quality work to the real doctors.

  3. REO SpeedDealer said,

    While I understand and agree with the genesis of mid-level providers, I have a problem with the way in which their practice seems to be ever increasing. I work with a fantastic PA who does the easy family practice type stuff, acute URI, toenail removal, simple laceration repair, well kid visits. We would drown without the help. However, easy is where it should stay. My concern is that before long, the doc shortage will allow a PA or NP to practice outside of their depth. And soon thereafter, the docs will be feeling the squeeze because smart people who understand opportunity cost will go to school for fewer years to yield a similar salary and have the liability fall on the MD’s license. Best of both worlds for the mid-level provider and headache for the doctor. I am 100% in favor of protecting physician income and liability with laws. I pray for a nationwide tort reform law to eliminate the majority of junk lawsuits. Right now I’m not living where I want to because my home city/state is one of the malpractice hells that many doctors, including myself, fled years ago.

  4. halfmd said,

    That’s something we can agree on. I want to keep mid-level providers within the scope of their practice as ancillary help for easier things. My example of giving Rx rights to psychologists was just so therapists could give SSRI’s and benzos as a adjunct to talk/behavioral therapy. I see no reason to have a patient make regular trips to an internist or psychiatrist for refills when someone else could provide that service just as easily. I draw the line at more extreme pharmacotherapies such as tricyclics and valproate. Also, I want to see psychologists practice under the license of a board-certified psychiatrist, despite calls from some Ph.D.’s who somehow believe that a 2-year masters degree qualifies them to practice alone.

  5. Medical Serf said,

    From the patient prospective: Having been on SSRIs and having a PCP and a psychologist work my case together, I really do not feel like my therapist new her ass from her elbow when it came to side effects and dosing my drug of choice. I would much rather have even a nurse practitioner dose my meds than a psychologist who hasn’t had nearly the pharm.

  6. medical student said,

    I agree with Halfmd. Lets say a PhD psychologist becomes a PA, i think that no one would we worried to see that practitioner provide med-management under physician supervision (in those states allowed to do so). And now lets say that we clone the PA training and enhance it to fit better on mental health issues, something like a Psychiatric PA. That should be the training that only Doctoral level Psychologist should take and that would let them practice under physician supervision.
    Where is the problem with that?? In fact that would be a better track for a psychologist than the separate Psychology + PA training.
    Medical Serf: we are not saying that a Psychologist with virtually no training on pharmacology and pathophysiology would assume that role. Just those doctoral level psychologist who take extra training (it should be a psychiatry enhanced PA route) and pass a national examination, and of course practice under supervision.

    The alternative is what we see nowadays: PhD/PsyD Psychologist want to be independent prescribers without the necessary training and ultimately become pseudo-psychiatrists, and that is exactly what it is going to happen if we dont take a rational approach. Rather than a Pseudo-psychiatrists we should better support that only PhD/PsyD Psychologists can expand their role via further specialized sort of enhanced PA training with the same practice conditions as regular PA´s.

  7. psychgirl said,

    If psychologists want prescribing rights, they should go back to school and become an m.d.
    We are living in America with CAPITALISM and the market works a certain way. Get the big gun, and you can play with the big boys(and girls)
    Are they going to take the lawsuits that come with prescribing?

    Half M.D.: Your second sentence is incongruent with the first. Capitalism implies that the market is shaped by supplier competitiveness and consumer demand. There is certainly a lot of demand for mental health in the United States, meaning that anyone who is qualified to provide that service should be able to; and that the best providers will make the most money. The problem comes in when psychiatrists hide behind protectionist laws to hold onto power—something that is very UNcompetitive and UNcapitalistic. To answer your question: mid-level providers should indeed carry malpractice insurance if they want prescribing rights.

  8. Petter Brabec said,

    I as a psychologist would be seriously concerned if I would get a license to prescribe without any solid knowledge of pharmacology, anatomy, microbiology histology etc.
    I would suggest a limited specialized education that would take some 2-3 years in order to cover this gap between M.D. and psychologists. Dentists have limited prescription rights on the basis of their limited specialized education.
    Today, pharmacology for psychologists is ridiculously cut and detrimental to the psychology itself. It does not make it easier or clearer when working with patients. Something should be done.
    Psychiatrists should be aware of their limited education about psychology, and not have the tendency to play pseudo-psychologists. The fact is: they are doctors and choose one or two branches of psychological approaches to practice (psychoanalysis, CBT). Is it enough to know it all? Obviously not, it’s too reductionistic and absolute. But they´ll get by. They are good at intervening in acute crises and prescribing medication. It is, by the way, here the big money lies.
    Is it a good decision to prescribe medication as a psychologist, I wonder? I say yes to it with a reservation. ONLY with adequate proper training. Having said that, it is not a disadvantage to psychologists to let others prescribe medication. It is, however, seriously to disadvantage of psychotherapy, when medication is given and it stops the psychotherapeutical process in the patient. In this process, the psychologists very often lose to the psychiatrists, that “know the best”. Suddenly, it is a matter of cooperation and proffessional judgement in relation to intervention and prognosis. It is here psychiatrists and psychologists differ.

  9. Therapy Now said,

    I always spent my half an hour to read this weblog’s content daily along with a mug of coffee.

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