Another low moment in the history of medicine was achieved. Louisiana joins
New Mexico in granting prescription writing privileges to psychologists, as
reported in the May 21 issue.
Our medical societies have voiced their disapproval of this appalling and
transparent act to pass off substandard treatment as improved access to health
care. Nationally our leadership continues to fight many battles to stop
psychologists from expanding their scope of practice. For the most part, we
are successful, but these two defeats have put us on a slippery slope. Further
defeats are not an option.
A reevaluation of what we say at the legislative level is in order. Our
current talking points are correct and just, but there is an 800-pound gorilla
in the room called "money" that we have avoided discussing.
Reportedly, this topic is taboo because the mention of money castigates us as"
greedy doctors who are only interested in preserving their turf."
This mythology avoids the central issue to the debate and leaves us vulnerable
to the mirage of improved access to health care via the
Today's health care problems are not about access; they are about
affordability. Increasing the number of lesser-trained prescribers will result
in huge medication costs that will outstrip any perceived savings from lower
office visit fees. Resultant lower office visit fees are also a fiction. It is
very un-likely that having achieved practice parity with psychiatrists and
inheriting increased practice costs, psychologists will prescribe at a lower
fee. Nor will the intent of increased accessibility to health care occur.
Psychologists are no more likely than others to stampede to inner-city ghettos
or the rural countryside to offer care to the underserved. The main interest
for psychologist prescribing is economic gain, unfortunately—much to the
detriment of our patients and our economy.
Reframing the debate in economic terms will no doubt lead to acrimonious
counter-charges, but the man hiding behind the curtain will be exposed and the
truth will out. Discussion of money will raise many issues, not the least will
be about limited resources and where best to spend our valuable dollars. How
much quality and competency each health care dollar buys and how prescribers
influence the overall cost of care will be explored. It's a discussion that's
understandable and provides us with a winnable argument. Examination of the
economics of prescription writing by psychologists will reveal that costs of
care will rise, and quality of care will go down. We owe our nation, our
patients, and ourselves this discussion. Lets talk money!