La., N.M., Differ On Training Needed For Psychologists To Prescribe

Legislation granting prescribing rights to psychologists in two states sets out different training requirements to qualify for those privileges. Compared with Louisiana, New Mexico requires more extensive and specific training, including the completion of a supervised clinical experience, according to an analysis by Paula Johnson, deputy director for state affairs in APA's Department of Government Relations.

The Louisiana regulations require that applicants for prescribing privileges hold a current state license to practice psychology with an applied clinical specialty. In addition, applicants must earn a postgraduate master's degree in clinical psychopharmacology or the equivalent, as approved by the Louisiana State Board of Examiners of Psychology, and must pass a national proficiency examination in psychopharmacology.

Instruction must include “anatomy and physiology, biochemistry, neurosciences, pharmacology, psychopharmacology, clinical medicine/pathophysiology, and health assessment, including relevant physical and laboratory assessment.”

The psychology board does not specify the amount of time to be spent on such studies, and no practicum is required.

New Mexico requires not only licensure but specifies that applicants hold a doctorate in psychology. Pharmacological training courses and the proficiency exam must be approved by both the New Mexico Board of Psychologist Examiners and the state's Board of Medical Examiners, implying at least some medical oversight of the process.

The New Mexico regulations also specify a minimum of 450 classroom hours of instruction in “neuroscience, pharmacology, psychopharmacology, physiology, pathophysiology, appropriate and relevant physical and laboratory assessment, and clinical pharmacoptherapeutics.” They also call for an 80-hour practicum in clinical assessment and pathophysiology, and at least 400 hours of supervised treatment of 100 patients. Both practica must be overseen by a psychiatrist or other “competently trained physician.”

The New Mexico law further requires that the educational component and the supervised practica be completed within the five years preceding application. There are two prescribing levels stated in the law. Psychologists hold a“ conditional prescribing certificate” for two years and practice under the supervision of a licensed physician. A full prescription certificate is issued after successful completion of this initial period. Psychologists must have malpractice insurance to obtain both the conditional prescription and prescription certificates.

At present, psychopharmacological training in Louisiana is offered by the California School of Professional Psychology, a division of Alliant International University of San Francisco, in cooperation with the Louisiana Psychological Association. Classes leading to a postdoctoral master of science degree in clinical psychopharmacology are offered on weekends in Baton Rouge. Alliant has conferred such degrees in California, Texas, and Louisiana, according to its Web site.

“California School of Professional Psychology's program requires psychologists to complete 450 hours of instruction and includes training that sensitizes practitioners to different cultural views and differences in the ways that men and women respond to prescription drugs,” said an Alliant press release.

The primary training provider in New Mexico is the Southwestern Institute for the Advancement of Psychotherapy, in Las Cruces. “The goal is to provide high-quality training regarding psychopharmacology, helping psychologists to work as primary health care providers, supporting emotional and physical well-being,” says the institute's Web site. The institute has had a collaborative arrangement with New Mexico State University (NMSU) in Las Cruces for about five years.

The institute's director, Elaine LeVine, Ph.D., said she had just completed the program, taught by experts from around the country, and had received her license to prescribe.

Two rounds of students, totaling 20 individuals, have taken the classroom portion of the training, and several were in the midst of the 400-hour practicum. Classes have been taught for the last five years on the NMSU campus by medical professionals, including doctors and nurses, said Luis Vazquez, Ph.D., an associate professor and head of the department of counseling and educational psychology in the School of Education. These courses meet the same requirements as other university credit courses. The department also oversees the 400-hour practicum, although the psychologists are directly supervised by physicians.

Academic psychologists, including those from the department of psychology at NMSU, are not involved in training postdoctoral candidates for prescribing privileges.

Louisiana legislation specifically calls for a “postdoctoral” master's degree. A proposal to include psychopharmacology in the predoctoral curriculum at Louisiana State University was rejected by the university administration, said Alan Baumeister, Ph.D., a professor and chair of the department of psychology, who teaches neuropharmacology.

At the University of New Mexico, John Gluck, Ph.D., a professor who holds appointments in psychology and in psychiatry, said in an interview there are ethical issues for both prescribers and patients in the way psychologists will be trained. Psychologists would do better returning for another degree at a comprehensive university, where faculty committees set up the curriculum and where there are other disciplines from which to learn. Adding an entirely new subject area to one's scope of practice is not “continuing education,” he said.

“Is this new training program adequate for the purposes for which it was intended?” asked Gluck, who served on a joint commission convened by the state psychology and medical boards to explore prescribing privileges for psychologists. “We don't know. Patients are being asked to participate in an experiment.”

Information on the California School of Professional Psychology at Alliant International University is posted at<www.alliant.edu/cspp/>; information on psychopharmacology training for psychologists at Southwestern Institute for the Advancement of Psychotherapy is posted at<www.siaprxp.com>. The text of Louisiana's psychologist-prescribing law and licensure requirements are posted on the Louisiana State Board of Examiners of Psychologists' Web site at<www.lsbep.org>. The same information for New Mexico is posted on the New Mexico Board of Psychologist Examiners' Web site at<www.rld.state.nm.us/b&c/psychology/index.htm>.▪