Psychiatrists and other physicians were able to halt progress on a record
number of legislative attempts to expand psychologist prescribing in states
this year. However, further attempts to expand psychologists' scope of
practice are still possible this year in three states.
Legislation to permit doctoral-level psychologists to prescribe medication
was introduced but stopped in nine states so far during the 2009 legislative
sessions. Two more state legislatures in which bills were introduced have not
yet adjourned for the year, and two more may introduce
psychologist-prescribing bills before they adjourn this year. This is the
largest number of states ever to propose prescribing legislation in a single
year, according to APA.
APA's district branches and state psychiatric associations have coordinated
efforts to halt such bills and address access-to-care problems that
psychologist-prescribing advocates have used as an argument for expanding
psychologists' scope of practice. Their efforts led to the defeat or lack of
action on 13 bills in nine states: Arizona, Hawaii, Illinois, Mississippi,
Missouri, Montana, North Dakota, Tennessee, and Texas.
Psychologist-prescribing advocates made their largest inroads in Oregon,
where a bill (HB 2702) was introduced to give the state psychology board sole
authority to design a training program for psychologists, grant them
licensure, and regulate the practice of prescribing psychologists.
The measure was supported by two well-placed
psychologist-legislators—one a Democrat and one a Republican. Their
support led to the Oregon House passing the prescribing bill in May. However,
the bill's opponents convinced state senators to amend the bill to replace the
prescribing authority with an "interim work group"—including
appointees of the state boards of medicine, psychology, and pharmacy—to
develop recommendations for an accredited training program for psychologists
to prescribe medications safely for people with mental illness.
The approved legislation will require the work group to evaluate the
training necessary to allow a prescribing psychologist to work with special
populations, develop recommendations for legislation to change current
statutes to accommodate prescribing psychologists, develop recommendations for
oversight of prescribing psychologists, and evaluate the training program's
The Oregon Senate passed the amended version, and the House agreed to the
Senate version of the bill in June. The governor is expected to sign the
measure. Further legislation will be needed in the next legislative
session—as early as a special session called for February 2010—to
create the authority for any prescribing program to get under way.
"This was the best we could hope for with the attitudes toward the
issue in this legislature," said John McCulley, executive director of
the Oregon Psychiatric Association, in an interview with Psychiatric
Physician advocates looking to halt expansions in the scope of practice of
allied health care workers have long faced strong supporters of such efforts
in the Oregon legislature. The support for expanded prescribing was seen in a
law passed this year that gives naturopaths prescriptive authority for
synthetic drugs. Previously, naturopaths were limited to prescribing"
naturally derived medicine," including insulin, penicillin, and
morphine, for example.
The outcome of the psychologist-prescribing push is "still up in the
air depending on the training regimen recommended," McCulley said.
Psychiatrists have urged the use of a training program similar to the type
provided to physician assistants, which is a medically based program that is
broader than just psychopharmacology instruction and more rigorous than the
program supported by Oregon's psychologist-prescribing advocates. The work
group recommendations are expected to be ready for legislative review in early
McCulley urged psychiatrists in other states faced with similar prescribing
campaigns to establish personal contact with their state legislators and
develop ongoing relationships with them as the best ways to fend off"
well-funded" psychologist-prescribing campaigns.
Although most state legislative sessions have ended for the year,
psychiatrists and their allies in three states continue to face the prospect
of attempts to advance psychologist-prescribing bills in 2009.
A bill (SB 180) to allow psychologist prescribing was introduced in
Wisconsin, for example, but later withdrawn after its sponsor expressed
concern that its training provisions were insufficient, according to Jerry
Halverson, M.D., legislative chair of the Wisconsin Psychiatric Association
Psychologist-prescribing advocates' "strategy has been to blur the
lines between psychiatrists and psychologists," Halverson told
Psychiatric News. "Legislators don't know any better if they
are not educated" on the consequences to patients that could arise from
granting psychologists the right to prescribe psychoactive medication.
The Wisconsin legislation to authorize the state's Psychology Examining
Board to establish a training program and oversee "prescribing
psychologists" had been discussed by legislators for several years, but
a bill had never been introduced. Although the author withdrew the bill,
psychiatrists remain wary after hearing that the bill's language may be
offered as an amendment to the state budget later in the year.
"Psychologists push it as an access issue, while for psychiatrists it
is a safety issue," Halverson said.
Advocates of expanding psychologists' scope of practice highlight the
findings of the only research on access to mental health care in
Wisconsin—a state prison study—to argue that both psychiatrists
and other physicians were in short supply in the state's rural areas. What is
left unsaid, according to Halverson, is that rural areas also lack
psychologists. A better way to address physician shortages is to encourage
more of them to move to rural areas through tuition-reimbursement programs and
expand use of telepsychiatry. Several Wisconsin psychiatrists already practice
telepsychiatry, but the substantial technological costs and low insurance
reimbursements have kept more from undertaking such efforts, Halverson
The WPA may undertake a statewide study that examines the extent of access
problems and ways to alleviate them.
Similar prescribing legislation was considered in Ohio this year.
The Ohio Psychiatric Physicians Association and individual psychiatrists
raised strong concerns when language to authorize a psychologist-prescribing
demonstration project was included in a massive criminal-justice bill. After
physicians raised concerns, the bill's supporters relented and dropped the
psychologist provision. However, a freestanding bill with similar language is
expected later this year.
Another prescribing bill is expected in Michigan, where the Michigan
Psychiatric Society has been working with allies to educate legislators on the
The Michigan and Ohio legislatures may remain in session until December