Psychologists Continue Push for Prescribing Rights
Despite stringent requirements, psychiatrists maintain it would pose a public safety risk
May 6, 2011—Psychologists are attempting to pass legislation allowing them to prescribe psychotropic drugs after Governor Ted Kulongoski vetoed such a bill in 2009. This is their fifth try.
House Bill 3523 continues to receive fierce opposition and lobbying pressure from the Oregon Pediatric Society, the Oregon Psychiatric Association and the Oregon Medical Association. Because of its $290,000 fiscal impact, the bill needs approval from the Joint Ways and Means Committee, and a hearing has not been scheduled.
Rep. Bill Kennemer (R-Oregon City), who practiced as a clinical psychologist for 25 years, sponsored the legislation. If passed, Oregon would become the third state, after New Mexico and Louisiana, to allow psychologists to prescribe drugs.
Under the legislation, psychologists would have to be certified by the Oregon Medical Board which would establish an oversight committee comprised of three physicians, including one psychiatrist and four psychologists, one of whom must have expertise in treating children. Psychologists could prescribe drugs to treat anxiety, depression, attention deficit disorder and other mental and emotional illnesses, but not narcotics.
There are other limitations built into the bill. A psychologist must have a master’s degree in clinical psychopharmacology, clinical training in physical assessments, pathophysiology, psychopharmacology and clinical management, and at least one year of experience in a mental health setting.
“There are so many safeguards built into this bill,” said Robin Henderson, past president of the Oregon Psychological Association.
But detractors insist that’s not enough and contend giving prescribing rights to psychologists poses a public safety risk.
“The biggest issue is not having people adequately trained to prescribe very powerful medications,” said John McCulley, lobbyist for the Oregon Psychiatric Association.
These are “powerful drugs,” he said, that can cause liver and kidney impairment, effect the brain, and other parts of the body. “It’s a prescription of medicine and should be done by those who have medical training.”
Tanya Tompkins, a psychology professor at Linfield College, agrees.
“As a psychologist, I’m not adequately prepared to practice medicine. And prescribing medicine is practicing medicine. This is a radical expansion of scope of practice. We're talking about a psychologist who may have not taken any biological sciences before going to graduate school.”
But psychologists already work with people in need of psychotropic drugs and can “work carefully” with their primary care physician, Henderson said.
“And, we ask, is it going to be helpful? A short term course with psychotropic medication can be very effective,” Henderson said.
There’s a stark division between the training and background of psychologists and psychiatrists, McCulley insists. Psychiatrists receive more scientifically-based training, while psychologists are trained to provide behavioral-based therapy—whether it’s cognitive behavioral therapy, or other therapies that emphasize stress reduction and exercise.
“We have a lot of different tools in our belt,” Henderson said.
It boils down to “medical training versus behavioral training,” McCulley said.
The bill would fundamentally “blur the lines between psychology and psychiatry,” according to Tompkins. “What we’re dealing with is a top-down push to redefine the profession of psychology.”
Her students at Linfield conducted a survey recently among 130 of the state’s 1,318 psychologists. Of the 83 who responded, 44 percent were in favor of prescribing rights, 7 percent said they’d pursue such training, while 36 percent were opposed.
Proponents insist the legislation would combat the shortage of psychiatrists in rural areas, giving people greater ability to receive medications. But McCulley disputes that idea. “It’s not going to increase access,” he said
Tompkins is fairly confident the bill won’t pass this session. “It doesn’t have the votes to pass the Senate this time,” she said, adding that it “will be close” in the House, which is split between 30 Democrats and 30 Republicans.
FOR MORE INFORMATION
To read previous articles from The Lund Report about psychologist prescribing rights, click here.
May 6 2011