What is not clear to me is how piling more regulation on top of that from courts, medical-licensing boards, state legislatures, federal mandates, and insurance panels will improve quality of care. By the same token, I cannot help but notice that nurse practitioners in my state (New Jersey) are rapidly taking over prescription of psychiatric medications in the CMHCs. In theory, they are supervised by a psychiatrist; the reality seems to be different. While psychiatrists are twiddling away their time trying to prove that they are competent to practice, lesser trained clinicians with less onerous requirements are taking over care of patients. It is for this reason that a group of nearly 1,000 APA members forced an APA-wide referendum calling for APA to oppose the new requirements (Psychiatric News, December 3, 2010).