Vermont aims for passage of prescriptive authority bill in 2024

Vermont psychologist Rick Barnett, Psy.D.

Could this help the prescriber shortage?

In 2017, Connecticut sought to join New Mexico, Louisiana, Illinois, Iowa, Idaho, and Colorado as the seventh state to allow qualified psychologists to prescribe psychotropic medications. The Connecticut Psychological Association submitted a Request for Review of Scope of Practice for Psychologists, citing a shortage of psychological prescribers across the country. The review was approved by the Department of Public Health, resulting in Senate Bill 966. It died in committee in the spring of 2019.

In the years since, the COVID pandemic has exacerbated the nation’s mental health crisis, making it even more difficult for people to get the mental health treatment they need. Even with the addition of psychiatric nurse practitioners, there are not enough available prescribers, and wait times can be several months, according to Amy Blackburn, PsyD., clinical psychologist in Portsmouth, NH.

“People are resorting to using their primary care providers who are not able to spend the time gathering information and understanding the emotional and psychological difficulties their patients face,” she said.

Even if only a fraction of licensed psychologists chose to obtain the requisite training to prescribe the difference would be significant. Leader of the Connecticut Psychological Association’s Prescriptive Authority for Properly Trained Psychologists Task Force Barbara Bunk, Ph.D, cited a Louisiana study that showed that nine percent of licensed psychologists in the state completed training to prescribe.

There are approximately 2,500 licensed psychologists currently practicing in Connecticut. If only nine percent decided to obtain prescriptive authority, there would be more than 200 more prescribers for Connecticut residents.

“Prescriptive authority for psychologists would save patients time and money, and allow them to handle psychotherapy and pharmacotherapy in one place rather than the patient needing to see multiple providers for the same issue,” said Vermont psychologist Rick Barnett, Psy.D.

Psychologists and advocates believe that the traditional 45-minutes weekly therapy sessions would allow prescribing psychologists to monitor the effects of psychotropic medication more thoroughly than a physician can with occasional 5-10 minute sessions.

“Psychologists with additional training would be uniquely suited to prescribing and/or consulting because of the depth and breadth of our experience and knowledge in the field of behavioral health,” said New Hampshire psychologist, Michelle Ronayne, Ph.D.

In Vermont, House Bill H.428—an act relating to prescribing by doctoral-level psychologists—received a hearing in March from the House Committee on Health Care. Barnett said work will be done in the off-session to generate support for passage in 2024.

He is optimistic about the bill, but has concerns about opposition from physicians who believe the required training is inadequate and that additional prescribers will complicate their ability to manage the overall health of their patients.

Connecticut bill SB 966 was voted down in large part because of objections of state psychiatrists who emphasized the importance of their extensive medical training.

“I believe that patients with mental health and substance use diagnoses deserve access to safe, quality, evidence-based care by qualified providers with proper medical training,” said Katherine G. Kennedy, MD in her testimony. “The minimal online courses and minimal clinical training described for psychologists would not meet the standard of care that extensive clinical experience and substantive, rigorous medical training does.”

Prescriptive authority laws are not identical amongst the six states in which they exist. However, they do share several fundamental criteria. All states require that licensed psychologists obtain a Master of Science degree in psychopharmacology and pass the Psychopharmacology Examination for Psychologists (PEP). At the beginning of practice, psychologists are required to work with a patient’s PCP for at least a short period of time.

Barnett said the training for psychologists to obtain prescriptive authority in Vermont would include significant additional requirements beyond the APA standard and that it would look a lot like Illinois’ laws, which allow graduate students to begin training at the predoctoral level.

This would provide aspiring psychologists the opportunity to earn a joint degree in psychology and clinical psychopharmacology. Candidates would be required to take several basic undergraduate science courses and spend at least a year doing clinical rotations in multiple medical settings.

“Passing this bill would give psychologists the ability to work with their patients in a more integrated way that would be beneficial for their overall health and well-being,” he explained. “Our current system just doesn’t allow for that.”