AAGP Position Statement: Psychologist Prescribing Privileges
Adopted by the Board of Directors of the American Association
for Geriatric Psychiatry in October 2004
Position 1: Prescribing privileges for psychologists
is a patient safety issue because psychologists are not qualified
to prescribe medication.
Rationale: Psychologists, who can earn a
PhD by taking only a single course in the biological basis
of behavior, are trained in the social and behavioral sciences
and provide services that do not physically invade the body
cavity, such as psychological assessment and psychotherapy.
During the training, which typically occurs in a non-medical
setting, they do not observe or participate in the treatment
of patients with medical illnesses or patients with comorbid
physical and mental illness. Their training and experience
is relating to patients with mental health conditions. This
limited training does not adequately prepare psychologists
to detect and treat concomitant non-mental illnesses or to
understand and deal with the interactions of psychotropics
with other medications prescribed to help other medical conditions.
The problem is exacerbated in the treatment of geriatric
patients, who are most often affected by comorbidities and
require a sophisticated level of medical expertise in all
phases of treatment, including prescription medications. Safe
patient care requires that the treatment of other illnesses
and the effects of other medications be integrated with the
use of psychotropics.
The psychotropic medications used to treat mental disorders
are among the most powerful available to modern medicine.
Psychotropic medications have potential disabling and deadly
side effects. For example, many antidepressant medications
can cause a stroke, coma, seizures and tremors. This situation
is further complicated among geriatric patients by the fact
that pharmaceutical studies on the safety and efficacy of
new drugs typically exclude older adults, making the medical
judgment required for prescribing even more important. There
are no simple algorithms for prescribing medications for geriatric
mental health patients.
Effective use of mediations to treat brain disorders requires
medical training, with a thorough understanding of physiology,
chemistry, drug interactions and medical problems that masquerade
as or cause brain malfunctions. Diagnosing and using medications
to treat mental illnesses such as clinical depression and
schizophrenia requires the same level of medical skill and
knowledge as diagnosing and treating heart disease or diabetes.
It is as important to know when not to prescribe as when to
prescribe.
Position 2: Psychologists do not have the
medical model training of non-physician providers who have
limited prescribing authority.
Rationale: Non-physician health providers
(e.g., nurse practitioners, clinical nurse specialists, physician
assistants, optometrists) who have prescriptive authority
have substantial training in the medical model, which psychologists
do not have. Furthermore, in most states, advanced practice
nurses and physician assistants are authorized to dispense
limited types of medications (e.g., birth control pills, antibiotics,
topical skin medications) under physician supervision. Podiatrists
and dentists, whose prescribing privileges are respectively
limited to the foot and the mouth, are trained in the medical
model.
Some psychologists do prescribe as licensed nurse practitioners
or physician assistants. This avenue to earn prescribing privileges
through medical education is open to them.
The prescribing training program proposed by organized psychology
will not provide psychologists with the medical training necessary
to prescribe psychotropic medications safely. The American
Psychological Association’s model curriculum for training
psychologists to prescribe -- a two-year program of evening,
weekend or home study courses -- requires only 300 hours of
didactic instruction, and a clinical practicum involving 100
patients. Continuing education courses on pharmacology taken
by psychologists are not approved by medical authorities or
medical colleges. Such psychology-focused and developed courses
are no substitute for medical education.
Position 3: There is no societal need to
grant psychologists prescribing privileges.
Rationale: There is no shortage of prescribing
professionals, nor is there consumer demand for additional
prescribers. Training psychologists to prescribe unnecessarily
duplicates health care services already provided by medical
professionals.
Psychologists are not geographically better situated to serve
rural populations, as they are generally located in the same
area as psychiatrists. The needs of underserved areas can
best be met by improving the mental health training of general
physicians and other medically trained practitioners, who
are more widely distributed than psychologists.
Granting psychologists prescribing authority would increase
health care costs. Psychologists’ liability insurance
would rise dramatically and additional training and regulatory
resources would be needed. These costs would be passed on
to patients and taxpayers.
Position 4: Prescribing authority for psychologists
would compromise patients’ access to effective collaborative
treatment.
Rationale: High quality and cost effective
treatment for mental health consumers can be provided by collaboration
between psychologists and medical professionals. This type
of collaboration has worked for many years.
The responsibility for patients’ medical care should
rest with those professionals who have medical training and
experience.
Position 5: The issue of psychologists’
prescribing is divisive within the profession of psychology.
Rationale: Many psychologists, both practitioners
and academicians, as well as the American Association of Applied
and Preventive Psychology (the American Psychological Association’s
clinical affiliate) and the Society for the Science of Clinical
Psychology (a division of the American Psychological Association)
oppose prescription privileges for psychologists.
Prescribing would change the nature of clinical psychologists’
practice and training at the undergraduate, graduate, post-doctoral
and continuing education levels. Many psychologists do not
want their profession to be legislatively defined.
Prescription authority, when sought by other non-physicians,
such as advanced practice nurses, was not controversial within
the profession because their training was already medical
in nature.
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