Psychologists scored a big win over psychiatrists last month when they gained the right to prescribe psychotropic medications in New Mexico.
House bill 170, which passed with little opposition in the state legislature, was signed into law by Gov. Gary Johnson, making New Mexico the first state to grant psychologists their long-sought prescriptive authority.
Psychiatrists, reeling from the news, hope it will be the last. Dr. Paul S. Appelbaum, incoming president of the American Psychiatric Association, said, "New Mexico should be seen as a sad anomaly, not the start of some perverse trend. ... There is no reason to believe that the peculiar set of factors that determined the outcome in New Mexico will recur elsewhere."
Psychologists welcomed the victory, but also did not view it as definitive. They anticipate lengthy continuation of difficult state-by-state skirmishes. In the last 10 years, 13 states have introduced enabling legislation, and bills are pending in Georgia, Illinois, Hawaii, and Tennessee.
Russ Newman, Ph.D., executive director of professional practice at the American Psychological Association, said that the new measure will improve access to quality mental health care in New Mexico, where psychiatrists are in short supply.
"Prescriptive authority is a logical evolution and growth of our profession," he said.
The speedy adoption of the New Mexico proposal surprised even its supporters. It was enacted in less than 2 years from the time it was first introduced.
Dr. Gail Thaler, president of the New Mexico chapter of the American Psychiatric Association, said rural access became the lobbying mantra of psychologists, and legislators readily picked up on it. She and other psychiatrists met with the governor on several occasions, but their testimony did not appear to phase legislators, who had previously granted prescribing privileges to nursepractitioners, physician assistants, and clinical pharmacists.
Describing mental health services in New Mexico as "dangerously inadequate," E. Mario Marquez, Ph.D., legislative chair of the New Mexico Psychological Association, said, "people realized that [passage of the bill] was the right thing to do."
Citing an APA-supported ad, lobbying, and direct mail campaign against the bill, Dr. Applebaum said, "the ultimate passage of the bill was not due to any lack of effort on the APA's part." He cited "the unique confluence of a number of factors, including some key legislators who championed the psychologists' position; the misguided decision by the state medical association to support a 'compromise'; and a governor whose impending departure from office freed him from concern about the harm that might occur to New Mexico citizens."
But the New Mexico lobbying efforts by the APA were deemed too little too late by some of its own members, who called for a more intense and widespread campaign to prevent the extension of prescribing privileges.
"Those psychiatrists who are in leadership positions, especially those who are leaders in the American Psychiatric Association, are wholly to blame for this disaster," said Dr. John C. Webber, assistant medical director of Youth Home in Little Rock, Ark.
"The APA has never made a serious attempt to get its 'message' out to the public the way the American Psychological Association has done. Even in 2002, we live in a society where a large percentage of lay people still do not understand the difference between a psychiatrist and a psychologist, so no wonder it isn't that hard selling the public on why it's no big deal for psychologists to prescribe medications," Dr. Webber said.
"This is a wake-up call," said Dr. Lee Beecher, president of the Minnesota Physician-Patient Alliance. "We can no longer expect that people will be deferential to [psychiatrists]." Psychiatrists need to work with primary care providers, providing consultation and support. …