April
2002

Prescription privileges: Some of my best friends are psychologists but…

One of the WICHE states, New Mexico, became the first state to pass legislation enabling doctoral level clinical psychologists to legally prescribe medications for their clients. The legislation passed with strong support in both the NM House and Senate, but with considerable opposition from organized psychiatry and medicine. Governor Gary Johnson signed the bill into law on March 5, 2002, and it becomes effective July 1. The legislature felt the extension of prescription privileges to psychologists fit logically into its previous actions extending more independent scope of practice to physician assistants and clinical nurse practitioners. The legislature also was concerned about the lack of psychiatric access and availability to rural New Mexico residents, and believed the legislation would provide potential relief.

Now what? The new law will enable the emergence of prescribing psychologists, but also requires training and continuing education, as well as a period of physician-supervised practice. Training and continuing education must be developed and approved by both the New Mexico Board of Medical Examiners and the Board of Psychologist Examiners. After meeting the criteria of training and supervised practice, the prescribing psychologist will be able to prescribe psychoactive medications with a high degree of independence. The hope is that this expansion in the scope of practice will result in enhanced access and continuity of care. The fear, expressed by organized medicine, is of professionals with limited medical training prescribing powerful pharmaceutical agents that have many potential side effects and risks.

While organized medicine/psychiatry called foul, will graduate medical education create barriers or seize the opportunity? The arguments against granting prescription privileges leveled by organized medicine really centered on the lack of medical training. Certainly one route to address these concerns would be for medical education to put forward a comprehensive program to meet the 450 hours of classroom training required by the new law. In the absence of such graduate medical education driven alternatives, other entities will fill the void. New Mexico offers an opportunity to define a curriculum that leads to quality integrated care.

Many other states have considered such legislation, and certainly more will now move in this direction, especially if the New Mexico experience is positive. The new law presents both new challenges and risks to the state mental health authority. Obviously, the enabling of psychologists employed in state facilities to prescribe will need to be considered, as well the potential for litigation should any consumer experience adverse effects. The state will also have to seek means to effectively integrate the practice of psychiatry and psychology in its institutions and the community. Since more than 90% of all psychologists and psychiatrists practice exclusively in metropolitan areas, will this law offer an opportunity to encourage providers to relocate to underserved areas? Finally, some of my best friends are psychologists, but I wonder if they have considered how this law will change the face of psychology. There will be opportunities, certainly, but there will also be challenges, risks, and losses.