Another low moment in the history of medicine was achieved. Louisiana joins New Mexico in granting prescription writing privileges to psychologists, as reported in the May 21 issue.
Our medical societies have voiced their disapproval of this appalling and transparent act to pass off substandard treatment as improved access to health care. Nationally our leadership continues to fight many battles to stop psychologists from expanding their scope of practice. For the most part, we are successful, but these two defeats have put us on a slippery slope. Further defeats are not an option.
A reevaluation of what we say at the legislative level is in order. Our current talking points are correct and just, but there is an 800-pound gorilla in the room called “money” that we have avoided discussing. Reportedly, this topic is taboo because the mention of money castigates us as“ greedy doctors who are only interested in preserving their turf.” This mythology avoids the central issue to the debate and leaves us vulnerable to the mirage of improved access to health care via the super-psychologists.
Today's health care problems are not about access; they are about affordability. Increasing the number of lesser-trained prescribers will result in huge medication costs that will outstrip any perceived savings from lower office visit fees. Resultant lower office visit fees are also a fiction. It is very un-likely that having achieved practice parity with psychiatrists and inheriting increased practice costs, psychologists will prescribe at a lower fee. Nor will the intent of increased accessibility to health care occur. Psychologists are no more likely than others to stampede to inner-city ghettos or the rural countryside to offer care to the underserved. The main interest for psychologist prescribing is economic gain, unfortunately—much to the detriment of our patients and our economy.
Reframing the debate in economic terms will no doubt lead to acrimonious counter-charges, but the man hiding behind the curtain will be exposed and the truth will out. Discussion of money will raise many issues, not the least will be about limited resources and where best to spend our valuable dollars. How much quality and competency each health care dollar buys and how prescribers influence the overall cost of care will be explored. It's a discussion that's understandable and provides us with a winnable argument. Examination of the economics of prescription writing by psychologists will reveal that costs of care will rise, and quality of care will go down. We owe our nation, our patients, and ourselves this discussion. Lets talk money!
