Prescribing psychologists: Is it the wave of the future?

Psychologists prescribing medication, also known as clinical psychopharmacology or medical psychology, is nothing new. Since, 2002 New Mexico’s psychologists have had this authority.

What is new, however, is the growth in the number of prescribing clinicians since then. In addition to New Mexico, Colorado, Utah, Illinois, Iowa, Louisiana, and Idaho—also provide psychologists with the authority to prescribe medications to their patients. The U.S. territory of Guam and all branches of the U.S. military also allow “prescriptive authority” to psychologists.

In New England, Massachusetts, Rhode Island, New Hampshire, and Maine make no allowance for this expansion.

In Connecticut, the Psychological Association has been advocating for prescription privileges, but no legislation has been approved.

Vermont is the only state in the region currently working on relevant legislation.
A prescriptive authority bill passed in the House and is currently with the Senate Committee on Health and Welfare.

The biggest hurdle for psychologists is to obtain a degree in psychopharmacology, which is the use of medications specifically targeting mental illnesses like depression, anxiety, schizophrenia, and bipolar disorder.

With a knowledge of drugs and their interactions, many states are keen to consider allowing psychologists to administer prescription drugs to their patients rather than having to go through a secondary referral to another doctor.

But major organizations like the American Medical Association are against psychologists having this ability. The organizations argue that psychologists are not sufficiently trained. The number of hours of education for a medical doctor or psychiatrist far exceed that of clinical psychologists and they feel this poses patient risk.

The groups are also apprehensive about what they term “scope creep” in expanding prescribing authority.

In an article posted on the AMA website, comments were published by Rebecca Weintraub Brendel, M.D., J.D., associate professor of psychiatry at Harvard Medical School and chair of the AMA Council on Ethical and Judicial Affairs.

She wrote about the level of training medical doctors have to prescribe medications. She said medical care “looks very different when you read about it in a book and then you see how it affects a person and what that looks like.”

Commenting on Vermont’s legislative moves, Krista Boyer, a psychologist in Pennsylvania, wrote an Op-Ed piece for the Pittsburgh Gazette advocating for her state to follow in Vermont’s footsteps.

She said prescribing psychologists in other states must earn an additional post-doctoral master’s degree emphasizing psychopharmacology and the biological basis of behavior, pass a rigorous national exam, and receive supervision in practice.

Boyer wrote the demand for mental and behavioral care, combined with a shortage of practitioners, calls for this approach.

“These psychologists would have expanded clinical training and would be providing holistic care, not just prescribing a pill, improving both new-patient and follow-up care,” she wrote.

Matthew Price, Ph.D., director of the clinical psychology training program at the University of Vermont, agreed with Boyer’s viewpoint. Rural areas like Vermont have a shortage of clinicians.

He believes there are model programs for physician assistants, medical doctors, and nurse practitioners and feels there’s no reason why psychologists cannot get the same kind of training.

However, he understands the reluctance expressed about prescriptive authority for psychologists.

“It’s a legitimate concern. There’s a range of adverse effects and reactions that need to be considered. But it’s a solvable problem,” Price said. “We desperately need more providers and services, so we’ve got to think outside the box as to who can do what.”

The training issue regarding risk factors and consequences is not insurmountable, Price added.

Although many clinical programs just touch on pharmacology, psychologists are often exposed to it through their practices and learn from interaction with other clinicians, he said.