David Greenfield’s office manager called 19 psychiatrists before she found one to return her call. This situation is not uncommon, according to Greenfield, Ph.D, an assistant clinical professor of psychiatry at the University of Connecticut School of Medicine, and founder and medical director for The Center for Internet and Technology Addiction in West Hartford.
“We see this every day,” said Greenfield, whose practice receives daily calls from individuals looking for a prescriber.
Connecticut, like many states, has a shortage of psychiatric medication prescribers. That shortfall means that people often have to wait weeks or even months for an appointment, Greenfield said.
For this reason, Sen. Mary Abrams advocated for SB966, a bill allowing psychologists to have prescription privileges in Connecticut. Abrams, who represents the 13th district (Cheshire, Meriden, Middletown, Middlefield, Rockfall), is part of the Public Health Committee, which introduced the legislation.
“Psychiatrists are very busy, and it’s hard to get appointments with them. Sometimes, they don’t take Medicaid and [other forms of insurance]. I know what a great job our clinical psychologists do with meeting the needs of Connecticut citizens. I thought this would be a continuation of that,” she said.
Because psychologists typically see patients weekly, and already have a strong therapeutic alliance with them, they’d be able to efficiently monitor the efficacy and tolerability of psychotropic medication, advocates believe.
Under SB 966, in order for doctorate-level psychologists to prescribe psychiatric medication, they’d need to complete a master’s of science in clinical psychopharmacology, receive clinical supervision from a physician or advanced practice registered nurse, and pass a national board exam.
Greenfield received his degree and passed the exam, noting it was an “amazingly valuable experience.”
On March 25, a public hearing was held, where the bill met with opposition. It’s been heavily opposed by those in the psychiatry field, whose criticisms largely center on psychologists’ lack of extensive medical background and knowledge base.
For instance, according to psychiatrist Linda Drozdowicz, MD, in her written testimony: “To treat a simple case of depression, one must understand all of the medical conditions that can mimic depression: brain tumors, autoimmune diseases like lupus or multiple sclerosis (MS), low testosterone, pregnancy, thyroid problems, and side effects from other medications, are just a few. Psychiatrists (PHYSICIANS) are well equipped to treat mental illness but also know when something medical is really the cause.”
The review committee established to evaluate the scope of practice—which included members from different medical organizations—was unable to reach a consensus and provide any recommendations for moving forward.
Currently, psychologists in Iowa, Idaho, Illinois, New Mexico, Louisiana, the military, U.S. Public Health Service, and the Indian Health Service have prescriptive authority.
Greenfield wanted psychologists to know that prescriptive authority wouldn’t affect malpractice rates for all psychologists. “For psychologists who do prescribe, rates will be 10 to 15 percent higher,” he said.
It also “doesn’t create a less desirable sub-group of psychologists who don’t prescribe. A rising tide raises all boats; as we strengthen the profession, we strength the ability for psychologists to help their patients,” he said.
Doctorate-level psychologists having prescriptive authority would set them apart from other mental health practitioners, such as licensed professional counselors, social workers, and marriage and family therapists, Greenfield said.
“Sometimes, these things are a process,” Sen. Abrams said. The next step is to re-raise the bill in 2020.
Margarita Tartakovsky, MS, is a Florida-based freelance writer and an associate editor at PsychCentral.com.
By Margarita Tartakovsky, MS