APA Armed and Ready to Fight Psychologist-Prescribing Bills
Scope of practice and related patient safety issues are top priorities for APA.
These concerns are so great that the Board of Trustees held an expanded retreat in June to consider these issues. We drew on the expertise of members across the country, staff involved in the issue on a daily basis, and, importantly, other medical specialties facing similar issues.
Armed with this good information, I have initiated a presidential task force to work with our policy councils and key staff and to advise the Board of Trustees on nonphysician scope-of-practice matters, particularly psychologist prescribing.
Other specialties agree that psychiatry is not alone in confronting assaults on safe patient care. Nonphysicians are attempting to expand their scopes of practice into several areas of medicine, including ophthalmology and anesthesiology, and it is essential that we put all that we know into this context.
Even leaders of the psychologist-prescribing effort see it this way (but for other reasons): at a recent debate (see page 8), Navy Cmdr. Morgan Sammons, who was representing the American Psychological Association, said prescribing psychologists are an “epiphenomenon”—one that coincides with changes in the health care system and the growth in number of physician assistants, nurse practitioners, and the like. His is an effort to cast psychology's attempts to gain prescribing privileges as an outgrowth of the coming of age and development of expertise of all nonphysicians as independent practitioners.
Here's some of what will inform APA's work on this issue, an effort that must grow in anticipation of the increased attempts psychology will launch in 2005:
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Many medical specialties are confronting scope of practice issues and the attendant patient safety concerns. Nonphysicians are seeking prescribing privileges not by virtue of training, but by legislative fiat.
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This is a marathon with many sprints. Specialty by specialty, state by state, year by year, bill by bill, we must advocate for our patients. Every district branch and state association must prepare for a sustained, multifront effort. It is critical to understand that nonphysicians are in this for the long haul. Psychologists worked on the issue for 20 years before they achieved success in New Mexico and Louisiana.
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Nonphysicians stand to gain, especially financially, from changing the status quo. They will try to cast physicians as defenders of the status quo, but we are not. For example, we strongly support mending the nation's broken mental health system, but we cannot agree that granting psychologists prescribing rights will improve patient care.
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State medical boards are independent of one another and often have their own politics to contend with. We must not shy away from encouraging them to join in this debate.
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State medical societies are also autonomous. They are also open to our full participation—opportunities we must take. If we do not, we cannot be certain they will participate at the level we need them to.
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Building relationships with legislators, regulators, and media is vital. Many physicians say they “don't do politics.” I am reminded of the old gem, “Those who don't do politics have politics done to them.” Surely, our patients lose out in this scenario.
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Psychologists are not likely to seek only prescribing rights; that's just the task before them for now. In Oklahoma, optometrists are not only authorized to prescribe, they can perform surgery on the eye with a scalpel. Could bills that create gatekeepers to the mental health system come down the pike?
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These are political struggles. If the battle for patient safety were based on the best science, the best medicine, or the best training, New Mexico and Louisiana would not have enacted their laws. We must find ways to encourage district branches and individual members to become activists for the long term with state legislators. Clearly, political action committee contributions are integral to our efforts.
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Nonphysicians are determined. We need short- and long-term strategies to ensure that we go the distance for our patients.
Many APA members have told me they feel that the psychologist-prescribing laws that two states have passed represent a great leap backwards in providing health care to Americans. I agree. Under my leadership, APA is committed to maintaining—and improving—the quality of care our patients receive.
The APA Board of Trustees, our Assembly, the Council on Advocacy and Public Policy, our medical director, the Department of Government Relations, the Division of Advocacy—indeed, the entire Association—stand ready for the 2004 elections and the 2005 legislative season.
I would very much appreciate hearing from you at [email protected]. Thank you. ▪
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Published online: 6 August 2004
Published in print: August 6, 2004
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