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In response to stepped-up efforts by psychologists to gain prescribing privileges, the APA Board of Trustees voted at its meeting in Washington, D.C., last month to have APA's Joint Commission on Government Relations (JCGR) and the Task Force on External Relations develop a plan for states to provide psychiatric consultation services to primary care doctors wherever there is a perceived need.
The measure also requested input from APA's Task Force on Rural Psychiatry. It stemmed from a report by JCGR Chair Ronald Shellow, M.D., describing new efforts by psychologists to exploit the dearth of psychiatrists in some localities as a rationale for psychologist prescribing.
Despite the recent defeat of a psychologist-prescribing measure in Hawaii, psychologists are stepping up their efforts to gain prescribing privileges, said Shellow. (The prescribing measure was killed in committee.) In addition to Hawaii, psychologist-prescribing bills have been introduced so far this year in three states-California, Georgia, and Missouri, according to Shellow. The psychologists are asserting that given the paucity of psychiatrists in some localities, psychologists need prescribing authority to properly serve such underserved populations.
"If we're serious about fighting this issue," remarked former APA president Jerry Wiener, M.D., APA must specifically counter the geographical-maldistribution strategy. APA must emphasize that absent a psychiatrist, it is the primary care physician, not the psychologist, who should prescribe psychiatric medication. Since not all primary care physicians have adequate knowledge of psychiatry, APA, through its district branches, should make consulting psychiatrists available for primary care doctors whenever necessary. This may require telephone or other forms of communications, but the ready availability of such consulting psychiatrists should be made clear to state legislators confronted with psychologist-prescribing measures, said Wiener.
The geographical distribution of psychiatrists varies from state to state, explained Shellow. In California claims of a paucity of psychiatrists are "entirely spurious," while in Montana they are not, he observed. In Montana, an informal effort by APA members led the state medical society to set up courses for primary care physicians interested in psychopharmacology. Physicians were also encouraged to use telemedicine consultations if necessary.
The issue is not unique to the United States, observed Derek Puddester, M.D., chair of APA's Committee of Residents and Fellows and a resident of Ontario.
Implementing the Board's action could be costly, and APA has limited resources, observed Member-in-Training Trustee Alisa Busch, M.D. The battle against psychologist prescribing could be "a bottomless financial pit for us," she said.
Although it may be costly, it is a priority worthy of a commitment of resources, said Shellow. APA has been successful in countering prescribing measures wherever they have arisen "by utilizing the support of the state medical societies," said Shellow. The issue resonates with the societies, who are accustomed to fighting other battles such as those surrounding ophthalmologists and optometrists, he added.
At the federal level, organized psychology is still trying to reopen the federally funded psychologist-prescribing demonstration programs, such as the now defunct Department of Defense program, said Shellow. Some members of Congress have expressed interest in pursuing a similar initiative, he said.
In other actions during the final day of the March meeting, the Board