As physicians stand by helplessly, our national health care system has changed dramatically over the past three decades. We’ve watched as managed care organizations with legislative authorization have diverted billions of dollars away from patient care to windfall profits. Nowhere have these changes been more dramatic or more destructive than in the field of psychiatric medicine.
In the face of these powerful destructive forces, physicians have turned to their national organization in search of an ally. We seek to strengthen our voice in the national debate to ensure that our perspective is heard for the benefit of our patients. I was therefore shocked and disheartened when I learned in the February 6 issue that "APA President Marcia K. Goin, M.D., and Medical Director James H. Scully Jr., M.D. . . . have secured the support of New Mexico Gov. Bill Richardson for medical board oversight of psychologists’ prescribing." Now with the input of APA’s top officials, the nation has a plan authorizing "safe" prescribing practices for psychologists.
The battle by psychologists for prescriptive authority has received an enormous boost. This disaster prompted me to write Drs. Goin and Scully requesting they resign so APA can disavow their endorsement of organized psychology’s agenda. But how could this have happened?
In talking with Dr. Goin, she explained her reasoning. I appreciate and respect her opinions, but doesn’t our leadership have a responsibility to represent us? We’ve listened for years to candidates claiming that APA has to become more responsive to the needs of its members. How can it be that the national organization has become so disconnected from the individuals it exists to represent? Without a national organization to champion our views, how can we hope to shape our nation’s health care policy? If APA doesn’t represent us, how can we support it?
APA President Marcia Goin, M.D., responds:
APA’s opposition to psychologist-prescribing attempts is longstanding, well-documented, and resolute. In every state, in every venue, at every chance, and in every way possible, APA is actively working with our district branches (DBs) and state associations (SAs) to vigorously oppose such schemes because they put patients at risk. Even in the wake of the New Mexico prescribing law, we continue to succeed in these efforts.
Over our strong objection, New Mexico passed a psychologist-prescribing law. APA members know that APA’s leadership committed very significant technical and financial resources to that battle, and the leadership and members of the DB there have ready access to APA resources and senior staff as they continue their struggle against this unwise and dangerous law.
We haven’t backed off, and we won’t. Our work continues on multiple tracks:
• Across the country, we are vigilant in lobbying against psychologists’ attempts to win prescribing privileges and in providing our DBs and SAs the resources they need to fight these battles locally.
• In New Mexico, we are working with the Psychiatric Medical Association of New Mexico (PMANM ) to respond to the pending regulations to implement the program—not because we approve of the law or believe it can be "fixed," but because we have an obligation to the safety of patients to highlight the deficiencies in the implementation proposal that was recently approved by the joint psychology-medicine board charged with developing the proposal.
• APA is at work with the PMANM and the medical school on an outreach program to ensure that patients in the rural parts of the state receive the quality medical psychiatric care they deserve.
Our meeting with New Mexico Gov. Bill Richardson had nothing to do with any proffered compromise. Rather, this was a timely opportunity to let the governor know of our deep concerns about a law he inherited from his predecessor.
I’m glad Dr. Kaye shared his anxiety over the situation in New Mexico. I share his deep concern, and I am committed to considering all appropriate responses in every venue to this most unwise threat to safe patient care. ▪