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By Elizabeth Millard
On May 6, Louisiana gave prescriptive authority to specially trained
medical psychologists. In order to prescribe under the new legislation,
medical psychologists have to earn a postdoctoral degree in clinical
psychopharmacology and then prescribe only in consultation with
a patient's primary care physician. Because of these rules, only
about 50 psychologists in the state are eligible under the bill.
The legislation makes Louisiana the second state in the country
to give prescriptive privileges, following New Mexico's lead.
"This is a victory for the people of Louisiana," says James Quillin,
Ph.D., M.P., president of the Louisiana Academy of Medical Psychologists
in a press release issued after the decision. "This is model legislation
that proves progressive change in our health care system is achievable."
Although two states don't usually indicate a trend, in this case
it could be a glimpse of the future. "We're delighted," says Russ
Newman, Ph.D., executive director for professional practice at the
American Psychological Association. "Some people had the tendency
to say that New Mexico was an aberration, that no one else would
go in this direction. Now that we have two states that have tried
to address this health care issue, we believe more will follow."
The issue at hand is one of access. In Louisiana, some patients
had to wait up to five months to see a psychiatrist. New Mexico
experienced similar access obstacles that led to that state's approval
of prescriptive rights. Newman notes that he expects prescriptive
authority to be brought up in at least eight other state legislatures,
all in locales that have access concerns, such as New Hampshire
and Maine.
Jack Hutson, executive director of the Rhode Island Psychological
Association, says that smaller, more populated states like Rhode
Island would be among the last to be granted prescription privileges.
However, he's eager to see the trend make its way northward. "We
certainly continue to believe it's important," he says. "We'd like
to see prescriptive authority in the Northeast, and in Rhode Island."
A move toward prescriptive authority for psychologists in other
states will most likely involve the kind of controversy seen in
New Mexico and Louisiana. When the bill was making its way through
the Louisiana legislature, there was intense opposition from some
physicians and psychiatrists, who insisted that the education and
oversight requirements were inadequate. They also balked at the
amount of authority that would be in the hands of professionals
who hadn't attended medical school. In response, the Louisiana Academy
of Medical Psychologists collected contributions for the fight and
hired a high-powered lobbying firm to argue their case to the legislature.
Newman says that despite the potential for debate, many legislatures
will look to Louisiana and New Mexico in the next few years to see
the success of their legislative efforts, and act accordingly. "When
state legislatures decide to make a move, they look around first,"
he says. "It's hard to be the trend setter. But when they see a
state breaking new ground, they wait, and when other states join
in, it takes the pressure off."
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