Psychologists in Tennessee want to prescribe medications for their patients, arguing that too many mentally ill people in that state have no access to psychiatrists or family physicians. For the third year in a row, they convinced state lawmakers to introduce a bill that would expand their scope of practice to permit them to prescribe.

While the bill failed on two previous attempts at passage, psychiatrists and other physicians were concerned about the idea’s momentum. The Tennessee Psychiatric Association (TPA) organized a multipronged strategy to ensure that the bill never made it out of committee. A major component of the strategy was to organize a broad and, as it turned out, extremely effective coalition of opponents to the notion that psychologists should be allowed to prescribe. The district branch obtained strong support from the Tennessee Medical Association, local chapters of the National Alliance on Mental Illness, and the academic community, said Greg Kyser, M.D., chair of the TPA Legislative Committee.

The medical staffs at Meharry Medical College and Vanderbilt University Medical School were especially generous, Kyser said, in particular the efforts of Michael Ebert, M.D., chair of Vanderbilt’s psychiatry department, who helped mobilize the medical school’s lobbying resources in the effort to defeat the prescribing proposal.

One tactic the Tennessee Medical Association (TMA) used that proved especially successful was coming to legislative hearings armed with data and maps clearly contradicting the psychologists’ major argument in favor of prescribing privileges.

The psychologists had insisted, as they had done in other states, particularly California, that they deserved prescription privileges because people living in rural, sparsely populated areas do not have access to psychiatrists and other physicians able to prescribe psychoactive medications. Their corollary argument is that psychologists have willingly set up practices in those areas that they claim physicians avoid.

But the medical association’s representatives used their testimony before the Health and Welfare Committee to display to lawmakers a map showing that residents of rural areas in Tennessee have greater access to psychiatrists and family physicians than they do to psychologists.

"The psychologists and their lobbyists overstated the case," commented Scott Smith, the TMA’s government affairs director. "After we presented the facts about rural access and the dangers of nonphysician prescription authority, there was no chance for the proposal to leave the committee."

The TPA concentrated its lobbying and educational efforts on hammering home two points to state lawmakers: that "there was no mandate from the public in favor of allowing psychologists to prescribe and that the only people pushing the idea were a small minority of the psychologist community," Kyser told Psychiatric News.

TPA representatives also came to the state house prepared with data gathered by their psychiatric colleagues in Georgia in a similar battle that showed unequivocally that the public in a neighboring state was strongly against granting psychologists prescription privileges. Also in their armamentarium, Kyser noted, was a recent article from the August 6, 1999, Psychiatric News describing a Louisiana survey on the same topic in which 87 percent of respondents said they wanted only physicians to be able to prescribe drugs for them and their families.

One of the most distressing elements of the whole process, Kyser emphasized, was the actions of the Tennessee Psychological Association during the legislative process. The psychiatric association had previously supported three legislative bills that were important to the state’s psychologists with the understanding that the psychologists would not back the prescribing bill when it was introduced.

"But they betrayed their commitment to us," Kyser said, "and actively pushed for the bill. They’ve burned their bridges, because until this happened, we had a good working relationship with them."

The president of the TPA, William Petrie, M.D., regretted that one source of support district branch leaders counted on failed to materialize. That was active involvement in the legislative battle by its own members, which was most disappointing in the TPA’s inability to convince psychiatrists to contribute funds to the fight.

"The response was fair at best," Petrie noted. "Many psychiatrists want a few of their colleagues to deal with these difficult issues."

Acknowledging that he and his Tennessee colleagues will probably have to deal with the issue again, Petrie observed that "many psychiatrists underestimate how easy it is to get a bill introduced and passed. [The psychologists] will often present bills to legislators who do not understand the difference between a psychiatrist and a psychologist" and believe that the two professions are interchangeable.

Petrie emphasized that a critical task facing psychiatric organizations throughout the country is to educate lawmakers about what skills and expertise psychiatrists possess that are unique and valuable contributions to medical care.

In Tennessee, psychiatrists and others opposed to giving psychologists prescription privileges are facing the imminent resurrection of the bill. While the last subcommittee to hold hearings on the bill voted not to recommend its passage, this recommendation is not binding on the full committee. And the chair of the full state senate committee with jurisdiction over the issue happens to be the senator who sponsored the bill, thus guaranteeing it will be on the agenda for the next legislative session.