Idaho Becomes Fifth State to Pass Psychologist Prescribing Law

Idaho Gov. C. L. “Butch” Otter (R) on April 4 signed legislation giving psychologists in the state the right to prescribe some medications after completing a postdoctoral master of science degree in clinical psychopharmacology and a supervised practicum in clinical assessment and pathophysiology, and passing a national examination.

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Under the new law, the training curriculum is equivalent to that required for nurse practitioners in the state. Psychologists seeking prescription privileges must spend two years under the supervision of a physician, and if they are prescribing to child, adolescent, or geriatric patients, they must be supervised by a child and adolescent or geriatric psychiatrist.

An advisory board—consisting of a psychiatrist, child psychiatrist, pharmacist, and two psychologists—will advise the state psychology board on proposed prescriptive rules and other regulations governing the prescriptive authority for psychologists, including any formulary or limited formulary. The state psychology board will not make rules governing prescriptive authority or formularies unless the rules have been approved by a majority vote of the advisory panel.

These requirements were built into the law through advocacy by psychiatrists from the Idaho Psychiatric Association (IPA). They said the state’s highly antiregulatory environment made it all but impossible for legislators to resist the arguments of psychologists who pushed the legislation as a no-cost way to expand access to mental health care.

“Our legislative environment is one in which most legislators want to allow people to make their own decisions,” James Saccomando, M.D., immediate past president of the IPA, told Psychiatric News, “and that includes allowing them to make their own mistakes. They didn’t want to listen to us tell them what isn’t good for them—they didn’t want to hear us tell them that psychologists don’t have the training to prescribe medicine. This bill was going to pass anyway, so we stayed at the table and pushed for a rigorous educational curriculum. Our logic was that since the law in Idaho already mandates a two-year curriculum for nurse practitioners to prescribe, then psychologists who want to prescribe should have to meet at least those prerequisites. We aren’t thrilled with the law, but we knew that if we walked away from the table, patients would get hurt.”

The state becomes the fifth in the nation to approve psychologist prescribing. The other states are New Mexico, Louisiana, Illinois, and Iowa.

“Psychologists continue to campaign for the right to practice medicine without going to medical school,” said APA President Maria A. Oquendo, M.D., Ph.D. “We are glad that the Idaho Psychiatric Association, working with the legislature, was able to shape the law to some degree. We will continue to monitor implementation of the law in Idaho and work with district branches and other medical groups to protect the safety of patients and the integrity of their care.”

APA CEO and Medical Director Saul Levin, M.D., M.P.A., said psychiatrists are the physicians trained to treat “mind, brain, and body” and understand how powerful psychotropic medications can affect multiple organ systems. He added that APA is committed to responsible ways to extend psychiatric expertise to expand access to care, while protecting patient safety. “APA is working hard to advance the practice of collaborative care through which psychiatrists, working with other health professionals, can extend mental health care to primary care patients,” he said.

Former IPA President and APA Assembly Rep. Charles Novak, M.D., was active in working with legislators to shape the educational requirements. He said that the training curriculum will begin at Idaho State University in fall 2018, and graduates of the program will be able to prescribe in 2020 with a two-year supervisory period.

He echoed Saccomando in saying that IPA and its allies, including the Idaho Medical Association, were fighting an uphill battle in the legislature. “The legislature here is very unwilling to spend money on much of anything, so if you can come up with something that appears to solve a problem and that doesn’t cost anything in the front end, their attitude is ‘Why not try it?’ But there is a shortage of psychologists in the state, and the idea that [prescribing psychologists] will move into rural areas in Idaho doesn’t make sense.”

Novak said psychiatrists from IPA hope to be involved in designing the specific curriculum according to the rules spelled out in the law. “[T]he didactic portion of the education shall be at least two years of full-time education … and shall be substantially equivalent to the education required of an advanced practice psychiatric nurse practitioner in this state.”

Broad areas to be covered in the curriculum include basic science; neurosciences; physical assessments and laboratory exams; clinical medicine and pathophysiology; clinical and research pharmacology and psychopharmacology; clinical pharmacotherapeutics; research; professional, ethical, and legal issues; application of existing law, standards, and guidelines to pharmacological practice; and relationships with pharmaceutical industry.

Saccomando, who will serve as the child psychiatrist representative to the advisory panel to the state psychology board, said that he would like the panel to develop a means to monitor psychologist prescribing in the state as well as patient outcomes associated with prescribing. ■