Psychologist Training Options Expand in Quest to Prescribe

When it comes to the question of how to educate psychologists about psychotropic medications so they can prescribe them, many have said the answer is for psychologists to go to medical school. Others, however, disagree with this stance, viewing it as a hard-line and impractical solution.

In preparation for the push by psychologists to gain legislated prescriptive authority, educators in psychology programs across the country have been setting up programs based on the curriculum developed by a panel of the American Psychological Association in 1996. The psychological association later developed and implemented a national certifying examination in psychopharmacology.

The model curriculum is aimed at doctoral-level psychologists with a current state license in good standing. The model suggests a two-part approach, involving both didactic and clinical instruction. The curriculum includes a minimum of 300 hours of instruction in courses at regionally accredited institutions of higher learning or “through continuing education courses.” Course work should include neuroscience, pharmacology and psychopharmacology, physiology and pathophysiology, physical and laboratory assessments, and clinical psychotherapeutics. Training participants are also required to pass a final examination.

For the clinical practicum, the model curriculum requires “an intensive, closely supervised clinical practicum during which the psychologist should work with at least 100 patients” in both inpatient and outpatient settings that involve cases using short-term and maintenance-medication strategies. Finally, the model curriculum stipulates that “the psychologist should undergo two hours of individual supervision a week [throughout the program] by a physician or other trained personnel and must attend seminars or colloquia as needed.”

Readers who think that the above is a far cry from medical school are correct. A psychiatrist puts in the equivalent of at least one academic year of coursework in the physical and biological sciences during undergraduate education and must successfully complete four years in medical school. Then comes internship and residency, amounting to another four to five years of education. In total, when most psychiatrists go into practice on their own, they usually have nine years or more of biomedical education backing up their legal right to sign a prescription.

The intensity and duration of a medical education make it superior to that of other professionals who have prescription privileges. For example, psychiatrists' preparation amounts to about three years more biomedical education than clinical pharmacists with a Pharm.D., who in some states can collaboratively prescribe a limited formulary.

Psychiatrists have about three years more biomedical education than most nurse practitioners, who prescribe in all 50 states, independently in 13 states and under some physician supervision in other states.

Physician assistants average three years of biomedical education and prescribe under physician supervision in 47 states. The original graduates of the Department of Defense Psychopharmacology Demonstration Project (PDP) completed as much training as most physician assistants. Students in the first PDP class completed 24 months of didactic training prior to a 12-month clinical rotation in both inpatient and outpatient settings. The subsequent three classes of PDP students completed 12 months of didactic and 12 months of clinical work.

The average prescribing psychologist wanting to write prescriptions legally in New Mexico or Louisiana will have on average completed the equivalent of one year of postdoctoral biomedical education when he or she begins prescriptive practice.

At least seven programs offer psychopharmacological training to psychologists. Using information available on the Internet, including the Web site of the American Psychological Association, Psychiatric News compared the available programs.

Many of the programs might be considered more rigorous than the original model curriculum—all programs meet the higher standard of a minimum of 450 hours of instruction set by both the New Mexico and Louisiana laws. The number of psychologists who have completed psychopharmacology training programs is reported to be in excess of 1,000, according to the American Psychological Association.

Just how well trained psychologists are in psychopharmacology depends upon which program they choose to complete (see table on facing page).

Four programs offer curricula culminating in the award of a postdoctoral master of science in clinical psychopharmacology.

The first degree program in clinical psychopharmacology was developed in 1998 by the California School of Professional Psychology in collaboration with Alliant International University in Alameda, Calif. At a cost just under $10,000, the Alliant program includes 450 contact hours (432 in “direct classroom instruction” and 18 in home study), offering 28.8 academic credits. The catalog notes, however, that “students living over 100 miles from a teaching site can attend through audio conference call using class handouts and videotapes of classes.” This “flex-plan” option requires students to attend at least eight weekends a year on site.

The Alliant catalog also notes that the program is offered at the level of a master's degree for two main reasons: to ensure students will “receive a credential that accurately reflects the level of rigor and the intensive nature of the training that they have completed,” and graduates will be interacting with other prescribing professionals, and as such, “an academic degree requiring examinations in each course is appropriate.”

Exams in each of the four degree programs are generally multiple choice and may be taken again if failed, and all course work is graded on a pass-fail system. The Alliant program has to date graduated “more than 200 psychologists in six states,” and “40 more will graduate in 2004,” according to the 2004-05 catalog.

The other degree-granting programs are similar to those of Alliant, with a few differences. Fairleigh Dickinson University (FDU) in New Jersey offers a slightly heavier program at 480 contact hours offering 30 credits. Though the bulk of the curriculum is delivered through a distance format, students meet five weekends during the training program.

Students who graduate from the program may elect to take a clinical practicum if they “desire to practice the management of psychopharmacotherapy in a supervised setting.” During this time they are exposed to the minimum 100 patients required in both the model curriculum and the two state statutes. The FDU catalog emphasizes that the program is different from others “in the degree to which both clinical and didactic instruction are emphasized.” It goes on to say that each student will have available not only the course instructor, but also “a facilitator, who is a practicing clinician involved in prescriptive practice. In most cases the facilitators have been nurse practitioners, although some have been physicians.”

Significantly, the FDU catalog notes that the program does not meet some aspects of the model curriculum, in particular, “practicum placement in both inpatient and outpatient settings. To our knowledge, no program in the country has so far been able to meet these criteria. We will comply with these requirements as they become more feasible.”

The program at the Massachusetts School of Professional Psychology (MSPP) offers an on-site program of courses on Fridays and Saturdays for 30 weekends over two academic years. For the 2004-05 academic year MSPP will offer an online program, which requires attendance on campus at nine specific weekends over the two academic years. The MSPP program also offers a track for advanced nurses who wish to learn psychopharmacology.

Differing from the other three degree programs, Nova Southeastern University's Center for Psychological Studies (Nova) program is offered as a campus-based, graduate-degree program as well as a “fly-in” program configured as five six-day extended weekends when students come to the Fort Lauderdale campus for classes Thursday through Tuesday, 9 a.m. to 5 p.m. The program is augmented by significant online resources. All candidates for the degree must complete requirements within five academic years.

Of the four degree programs, Nova places the most emphasis on the practicum. The Nova program requires two “100-hour, intensively supervised clinical experiences, ordinarily scheduled in the summer terms, where a minimum of 50 patients is seen during each practicum.”

The program catalog emphasizes that students should spend 100 hours or more with a mentor who is “qualified”—“a boarded psychiatrist or an otherwise equally qualified medical practitioner.”

Undoubtedly, as more states grant prescriptive authority to psychologists, more programs will develop, most likely in the model of the postdoctoral master's degree formats outlined in the New Mexico and Louisiana statutes.

In New Mexico, the Southwestern Institute for the Advancement of Psychotherapy is collaborating with the New Mexico State University (NMSU) and offers professional development credits on an NMSU transcript. The program is seeking degree-awarding authority.

Two certificate programs also are available. The Prescribing Psychologists' Register in Miami offers a distance-learning model of either just over 300 hours or the 450 needed to meet the current statutes. To complete the certificate, the candidate must complete a practicum involving 100 patients under a physician preceptor.

The Psychopharmacology Institute, based in Lincoln, Neb., offers an entirely online certificate program composed of 496 hours; its credits are“ transferable to two regionally accredited institutions for a postdoctoral master's degree in psychopharmacology.”

Regardless of which program a psychologist chooses, none is the equivalent of a medical school education. Indeed, one program includes in the course description for the first course in its curriculum the topic “Why psychologists will never become `minipsychiatrists.'” ▪