Psychologists Likely to Gain Prescribing Rights in Special Session

Among bills during next month’s special session is one that could end a decades-long battle between psychiatrists and psychologists in Oregon over prescribing

January 28, 2010 -- Robin Henderson knows first hand that central Oregon has a shortage of psychiatrists. As the director of behavioral health at St. Charles Medical Center in Bend, Henderson and her staff regularly encounter patients who require both therapy and medication. And the only physicians who can do both are psychiatrists.
 
“What I see is the provider problem,” Henderson said. “There just aren’t enough doctors who want to be psychiatrists. As somebody who has worked in mental health for the past 25 years, I’ve got to look at everything I can that makes sense.”
 
Primary care doctors and not mental health experts prescribe an estimated 75 to 85 percent of all mental health drugs in America, said Henderson, who believes giving that ability to psychologists is a better idea. Already equipped with the training to diagnose and treat mental illness, psychologists in growing numbers support the idea.
 
“From where I sit, I think this is a valid part of the solution,” Henderson said. “It’s proven, it’s safe and it’s the direction we need to go.”
 
In the upcoming special session that starts on Monday, the Oregon legislature could finally put to rest a long-standing debate between psychologists and psychiatrists over prescribing rights. It’s a debate that’s been going on at the state capitol for as long as most longstanding Salem lobbyists can remember. But there are still differences to resolve.
 
If lawmakers grant psychologists the right to prescribe mental health drugs, Oregon would become the third state in the country to do so, but not without precedent going a bit further back. For the past 15 years, the Department of Defense has trained and authorized psychologists to prescribe drugs as a way to meet growing demand coupled with a physician shortage.
 
Sen. Laurie Monnes-Anderson spearheaded efforts to have the two professions iron out their differences in a workgroup comprised of three physicians, three psychologists and a pharmacist. The group reached consensus, which is now represented in Senate Bill 1046 pending before the legislature. 
 
Monnes-Anderson said the process holds promise for other scope-of-practice issues that typically come before lawmakers. The work group brings clinical expertise into the discussion while the legislature still makes the final decision. No other medical specialty is currently engaged in such a process, but naturopaths earned limited prescribing rights through a similar workgroup before passing a bill last session.
 
“The process they took was a good one,” Monnes-Anderson said. “A citizen legislature has a responsibility of determining whether a profession has a qualification or not to expand their scope.”
 
The work group among psychologists and psychiatrists settled on pre-clinical training requirements and an 18-month residency training program for any psychologist that wants to prescribe drugs. Those exact recommendations became SB 1046, which the Oregon Psychological Association fully supports.
 
But the Oregon Psychiatric Association opposes the bill unless a few changes can be made, said John McCully, its lobbyist and executive secretary. “We are proposing amendments that if adopted would allow us to drop that opposition.”
 
Those amendments would allow psychologists to only prescribe drugs to adults – not children – require that any training be conducted in person and that the 18-month residency training be clearly defined as a full-time endeavor, McCully said.
 
“The entire medical community wants to make sure that patients are protected, that they’re provided the safest services as possible with some of the most powerful and dangerous medications that can be prescribed,” said McCully, who rejects the argument that psychiatrists are protecting their turf.
 
“We know there is concern from other psychologists that this is the wrong thing for their profession to do,” McCully said.
 
Henderson stood by the recommendations of the workgroup, which she said worded the language very carefully.
 
“This is a normal extension of where the field has gone,” Henderson said.
 
Come next week it will be up to the politicians to decide the fate of this issue.
 
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