Compromised Care

I am writing in response to the president's column in the May 5 issue titled “How Will Psychologists Practicing Medicine Affect Psychiatry?”

While I applaud Dr. Steven Sharfstein's acknowledgement that“ prescriptive authority” is the practice of medicine, I have a different view and a different answer to his rhetorical question.

First, the campaign is for parity. The mislabeled prescription bills authorize state boards of psychology to define, license, and grow a practice of medicine for psychologists. Psychologists in California and elsewhere have also initiated legislation, regulation, and litigation to expand independent authority to manage medical care for people at the office, in hospitals, and in jails and prisons. The recent manifesto by Division V of the California Psychological Association specifically identifies medical, economic, and career parity with psychiatrists as the campaign goal (see<division55.org/Pages/RxPBenefitsAll.htm>).

Second, this is a public policy debate, not an argument with psychologists. Here is the issue: Shall there be a separate, second-class standard for the medical care of people with mental illness?

Third, economics will determine the consequence, not quality. If legislatures permit two standards of care, institutional buyers—governments and health-care plans—will go for the cheaper standard. Medical education will be priced out of the mental health care market.

Fourth, it's about the future. Medicalized psychologists will replace, not add to, the psychiatric workforce. Future mental health providers will take the less expensive, more lucrative career path. Future medical students will seek careers that value fundamental medical education. Mental, like dental, will be referred out of medical curricula and medical practices.

Answer: The ultimate mental health carveout—bad for psychiatry, disaster for people with mental illness.