Why Psychologists Should Not Be Licensed
to Prescribe Psychiatric Drugs
Stephen Barrett , M.D.
Since 2002, the American Psychological Association and many state psychological associations have sought passage of state laws that would enable psychologists to prescribe psychiatric medications to their patients . Psychologists have also stepped up efforts to establish psychopharmacology training programs .
In March 2002, New Mexico became the first state to authorize psychologist prescribing. Its law (HB 170) enabled psychologists to acquire a two-year license to prescribe under physician supervision by:
- Completing at least 450 hours of coursework that includes psychopharmacology, neuroanatomy, neurophysiology, clinical pharmacology, pharmacology, pathophysiology, pharmacotherapeutics, pharmacoepidemiology, and physical and laboratory assessments.
- Completing a 400 hour/100 patient practicum under physician supervision
- Passing a national certification examination.
Then, if the supervisor approves and the psychologist's prescribing records pass an independent peer review, the psychologist can apply to prescribe independently. To maintain prescribing abiltiy, the psychologist must carry malpractice insurance, complete 20 hours of continuing education annually, and collaborate with the patient's primary physician. The new law also enables prescribing psychologists to order relevant laboratory tests.
The key question is whether training of this type will enable psychologists to prescribe safely and effectively for their patients. The American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Society for Geriatric Psychiatry, and many individual psychologists believe that the answer is no. I agree with this position.
The American Psychiatric Association labeled New Mexico's new law "the result of a cynical, economically-motivated effort by some elements of organized psychology to achieve legislated prescriptive authority without benefit of medical education and training." In a strongly worded statement, APA president Richard K. Harding, M.D., said:
We believe that the legislature and the governor in New Mexico have placed patient health and safety at risk. . . . By virtue of their training and education, psychologists simply do not have the background or experience to safely and effectively use powerful medications in the treatment of mental illnesses. Psychologists have always had a clear path to prescribing privileges: medical school. No psychology-designed and administered crash course in drug prescribing can substitute for the comprehensive knowledge and skills physicians achieve through medical education and rigorous clinical experience. . . .
Over the past decade, 14 state legislatures have rejected psychology prescribing legislation after objectively considering the scientific data and the public health risks of placing potent medications for treatment of mental illness in the hands of people with no medical education or residency training. We hope that they will continue to do so in the future .
The Society for the Science of Clinical Psychology (SSCP), a section of the American Psychological Association, has also opposed psychologist prescribing. Its members have been concerned not only that patients will be improperly treated, but also that psychologists will face serious legal risks. In 2001, SSCP members voted 98-6 to adopt a position statement which said (in part):
- No satisfactory precedents exist, either for designing suitable training programs or for predicting psychologists' performance as prescribers.
- Few existing psychologists would be able to complete any acceptable training program.
- Graduate education in basic psychological science and psychosocial treatments would be severely diminished and distorted unless most or all biomedical coursework were at the postdoctoral level.
- Malpractice premiums would go up for those who elect to prescribe, and possibly for all licensed psychologists, whether they prescribe or not.
- Should even a few malpractice suits against prescribing psychologists based on claims of inadequate medical training be successful, insur-ance coverage would become prohibitively expensive or disappear altogether.
- Psychologists would be exposed to patients' demands for 'pill fixes" and the blandishments of the pharmaceutical industry, just as psychiatric and other medical professionals already are .
In 2004, the American Society for Geriatric Psychiatry adopted a similar position:
- Prescribing privileges for psychologists is a patient safety issue because psychologists are not qualified to prescribe medication.
- Psychologists do not have the medical model training of non-physician providers who have limited prescribing authority.
- There is no societal need to grant psychologists prescribing privileges.
- Prescribing authority for psychologists would compromise patients’ access to effective collaborative treatment.
- The issue of psychologists’ prescribing is divisive within the profession of psychology .
I oppose psychologist prescribing because I don't see how it is possible for a one-year course to adequately prepare nonphysicians to prescribe psychatric drugs. To properly prescribe drugs, it is necessary to know when they should be prescribed, when they should not be prescribed, how they might interact with other drugs, what side effects might occur, and what to do when adverse effects do occur. If new symptoms occur, it is important to know whether they are related to taking a drug or represent a new problem that requires medical care.
Psychiatrists undergo four years of medical school during which they learn biochemistry, physiology, pharmacology, and diagnosis. Then they have at least three years of full-time postgraduate psychiatric training during which they typically prescribe drugs (under supervision) for hundreds of patients. And once in practice, the vast majority learn more by reading journals, talking with colleagues, and attending continuing education courses. I don't see how a part-time one-year course can provide anything comparable for psychologists.
- New Mexico Governor signs landmark law on prescription privileges for psychologists. APA Online, March 6, 2002.
- State of the states: Psychologists' prescribing privileges. American Psychiatric Association Division of Government Relations, February 2002.
- Harding RK. New Mexico psychologists prescribing law: Bad medicine for patients. American Psychiatric Association media advisory, March 6, 2002.
- Bush WJ. SSCP Task Force Statement on Prescribing Prvileges (RxP). Clinical Science, Winter 2001, pp7-11.
- AAGP position statement: Psychologist prescribing privileges. Amrican Association for Geriatric Society, Oct 2004.
This article was revised on March 28, 2008.