Nonphysician prescribing, drug industry pressure may influence debate's outcome.
SAN FRANCISCO - Psychology remains a field divided in the quest for prescribing privileges.
In multiple sessions at the annual meeting of the American Psychological Association (APA), psychologists, who have campaigned for years to win the right to prescribe, warned about the enemy within-colleagues who oppose prescription privileges for their profession.
Psychologists on both sides of the divide called the change inevitable but voiced different opinions on why it may happen and whether it would be a change for the good. Some said market forces such as the increasing use of nonphysician health care providers in the modern era will help propel prescription privileges. Others believe the pervasive influence of pharmaceutical companies will expand the right to prescribe in order to increase industry profits.
Bills introduced in 11 state legislatures in the past decade to give prescriptive authority to psychologists rarely have moved past committee consideration, although New Mexico lawmakers came close to voting on a prescribing law in the past year.
Legislators in the U.S. territory of Guam overrode the governor's veto to give psychologists prescriptive authority there in 1999.
Psychologists have formed task forces in more than 30 states to expand the legislative drive, said Morgan T. Sammons, Ph.D., director of mental health at the Naval Medical Clinic, Annapolis, Md. Dr. Sammons was one of 10 psychologist graduates of a military demonstration project in psychopharmacology training that was discontinued in 1997 after a General Accounting Office report cited the expense of their training and a lack of need for their services.
Although psychiatrists and other physicians form the backbone of opposition to these legislative efforts, some of the most damaging testimony comes from other psychologists who want the profession to remain prescription free, several speakers said at the meeting. Some members of the APA's Clinical Psychology Science Section started a drive to suspend APA funding for prescriptive authority advocacy, and some psychologists actively lobby politicians against a change.
Psychologists who oppose the right to prescribe say it would alter the cognitive, behavioral, and psychoanalytic focus of the profession, further pit psychologists against each other, and put them in competition with physicians, advanced practice nurses, and physician assistants.
Legislators are left to decide what portion of the opposition-by psychiatrists and psychologists alike-results from simple turf battles.
The American Psychiatric Association remains staunchly opposed to any prescribing authority for psychologists and emphasizes the lack of medical training that could lead to patient harm if psychologists prescribe.
Asked to comment, Dr. Michael Meek, a member of the governmental affairs committee of the California Psychiatric Association, said that prescriptive authority for psychologists is hardly inevitable, but "anything is possible."
Dr. Meek of Sacramento added "I think if the legislators and public are educated to the fact that psychologists are not medically trained and they cannot learn how to prescribe psychotropic medications competently just by taking a few courses, ultimately they will not prevail. …