The Pros and Cons of the Prescribing Psychologist

In 2002, New Mexico became the first state to allow psychologists to prescribe medication to patients. Up until that point, only psychiatrists had that ability.

Since then, the prescribing psychologist movement has spread into other states, including Louisiana, Illinois, Iowa and Idaho.

Some question whether this is a good strategy for patients in the long run.

Proponents say the change has given patients, especially those in rural areas where few psychiatrists are available, better access to medication to treat mental disorders. Opponents voice concern that psychologists lack the knowledge and experience gained by psychiatrists in medical school and clinical residency.

It’s a debate expected to continue as more states consider allowing prescribing psychologists.

History of Prescribing Psychologist Movement

The roots of the prescribing psychologist movement go back to the 1960s. That’s when the American Psychological Association (APA) officially recognized psychopharmacology as a discipline of psychology.

The Department of Defense, between 1991 and 1997, began allowing some psychologists to prescribe medication to members of the Armed Forces. The program involved a select group of 10 psychologists specifically trained in prescribing medication safely.

The next decade, lawmakers in both New Mexico and Louisiana passed legislation allowing trained psychologists the right to prescribe medication. The movement became known as RxP. Illinois (2014) and Iowa (2016) joined the ranks of RxP states, as did Idaho in 2017.

Some of the states where lawmakers have at least considered introducing legislation to allow prescribing psychologists include Florida, Kentucky, Minnesota, New Jersey, New York, North Dakota, Ohio, Texas and Vermont.

The Pros of Prescribing Psychologists

The main argument for allowing psychologists to prescribe medicine is that it increases access to full mental health services for those living in rural or poorly served areas where not many psychiatrists have offices.

Job numbers clearly illustrate the issue. The Bureau of Labor Statistics (BLS) reports there are almost 167,000 psychologists working in the United States. However, the BLS states that there are only 27,500 psychiatrists. Meanwhile, the National Council’s Medical Director Institute reported the ongoing shortage of psychiatrists is leading to a “health crisis.” Demand may outpace supply of psychiatrists by as much as 15,600 by 2025, the report found.

Idaho offers a good example of how those numbers play out across the country. Much of the state’s population lives in rural areas where a psychiatrist is hard to find. For example, the wait times to see a psychiatrist in northern Idaho were as long as year, according to Psychology Today. Having psychologists able to prescribe medication is required to get needed drugs to patients in the state faster.

Another pro is that patients do not have to visit multiple providers – for example, a psychologist for therapy session but a physician or psychiatrist for medication.

The Cons of Prescribing Psychologists

Despite these advantages, many remain concerned about psychologists not having the proper training to dispense medicine. The American Psychiatric Association argues that it’s an issue of patient safety, adding that prescribing medication is “not a right, it is a privilege earned after stringent education requirements are met.”

Those include coursework in biology, chemistry, biochemistry and physiology, as well as clinical experience that leads to a better understanding of how the body interacts with medication.

In response to concerns about knowledge, the APA has released guidelines for prescribing psychologists. In the states where prescribing psychologists are allowed, they must have a doctorate and a postdoctoral master’s degree in clinical psychopharmacology.

Still, psychiatrists argue that rigorous medical training cannot be replaced. Leaders in the field have said the answer is getting more people to do the serious training needed to become a psychiatrist.

Still, the advantages of prescribing psychologists will likely lead to more states allowing them. For those interested in the psychology field, it’s an issue to monitor. Widespread acceptance of prescribing psychologists could lead to big changes within the profession.

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