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Clips on Scope of Practice Issues

Explain To Me Again Why Psychologists Can't Prescribe Meds?
Steven Balt, MD

I recently gave a presentation to a Continuing Education program sponsored by the California School of Professional Psychology. My audience was a group of “prescribing psychologists”—licensed psychologists who have taken over 500 hours of psychopharmacology course work in addition to the years to obtain their psychology PhDs.

By virtue of their core training, these psychologists do not see patients as “diseases” or as targets for drugs. Although they do receive training in psychiatric diagnosis (and use the same DSM as psychiatrists), neuroanatomy, and testing/assessment, their interventions are decidedly not biological. Most of them see psychotherapy as a primary intervention, and, more importantly, they are well versed in determining when and how medications can be introduced as a complement to the work done in therapy. Most states, however (including my own, California) do not permit psychologists to obtain prescribing privileges, resulting in a division of labor that ultimately affects patient care.

...The bottom line is that there are ways of delivering mental health care in a more rational fashion, by people who know what they’re doing. As it currently stands, however, anyone with an MD (or DO, or NP) can prescribe a drug, even if others may possess greater experience or knowledge, or provide higher-quality care.  

New Listserve for RxP Consultations
There is a new Listserve, The National RxP list, which  is described by its coordinators as “a friendly place for training and active prescribing psychologists to seek peer consultation, share relevant literature, training opportunities, and practice tips. We hope to replicate the supportive, “never worry alone” culture of prescribing psychologists in New Mexico and Louisiana on a broader scale -- particularly for those prescribers who are geographically isolated. We are also looking forward to supporting new prescribers as the states pass prescriptive authority, offering a safety net of informal consultation with a group of experienced prescribing psychologists. A national forum also allows us to respond more quickly as a discipline when needed. This list is currently moderated by Elaine Levine (NM), Beth Rom Rymer (IL) and Nadia Webb (LA). To get information on participating in this listserve, you can email Nadia Webb

Inside a Mental Hospital Called Jail

Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review

American College of Physicians Hedges in Debate on Scope of Practice for Nurse Practitioners

Legislature Fails To Advance Nurse Practitioner Scope-of-Practice Bill

Bureau of Labor statistics that include California data on the prevalence of psychiatrists. Scroll down on the webpage.

California pays psychiatrists five times more than governor

Doctors lobby to reduce health care labor shortage, leaving out nurses, others  

The Alabama Board of Medical Examiners is scheduled to meet today to discuss the issue further. FTC Letter to Alabama Board of Medical Examiners:  

With Doctors in Short Supply, Responsibilities for Nurses May Expand  

California Psychiatrists paid $400,000 Shows Bidding War Federal court ordered California to provide adequate care for mental inmates. Read Bloomberg article at  

Senator Hernandez expansion of Scope of Practice for Optometrists, Pharmacists, and Nurse Practitioners:  

Mind Over Meds (Daniel Carlat on why meds aren’t enough):  

Who Should Provide Anesthesia Care?

The battle wages on in Illinois, with the same tired arguments,0,2146824.story

Senate hearing on three scope of practice expansion bills:

Will Training More Doctors Improve Health Care?



Psychologists Prescribing: The Best Thing That Can Happen to Psychiatry
The Carlat Psychiatry Blog

....Today I want to touch on what is probably the hottest topic in psychiatry: whether psychologists should obtain prescription privileges. This is topical because Oregon just overwhelmingly passed a law authorizing prescriptive privileges for psychologists, although it is unclear whether the governor will sign the bill.

I endorse psychologists prescribing, and here's why: it would be the single best thing that could happen to psychiatry. Yes, I know it sounds ridiculous, but here's my reasoning. Psychiatry has boxed itself into a tiny corner of medicine called "psychopharmacology." It's a silly way to practice our craft, because the essence of what we do is to understand the mind and to help people live better lives. Drugs are effective but only one of the tools available to us, and we have largely ceded psychotherapy to psychologists and social workers. The result is a fragmentation of care. You see your "p-doc" for your meds, and you see your therapist for your mind. Each professional is far too busy to communicate with the other. 


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