Published Apr 2, 2002
Thought this was interesting. It will be interesting to see what changes this may bring. Here is the article:
Debate still continues on prescribing drugs
By Nancy Salem
New Mexico is the first state to allow specially trained psychologists to prescribe psychotropic drugs like Prozac, Zoloft and others used to treat mental disorders.
Bills passed by the 2002 Legislature and signed by Gov. Gary Johnson give psychologists prescriptive authority in consultation with a primary care physician and under certain conditions. The legislation is similar to a bill that was passed by the House in 2001 but wasn't called up by the full Senate.
The psychologists' victory hasn't quelled the debate that simmered last year.
Psychiatrists, who are medical doctors, say psychologists, who aren't, don't have the training to prescribe medication for mental illness.
"Our concern is about quality of care for the people of New Mexico and ensuring and protecting their health, safety and welfare," said Neil Arnet, past president of the Psychiatric Medical Association of New Mexico.
"It remains to be seen exactly what program is going to come out of this. But, for sure, as it is structured now, this program has inadequate training, and that is unsafe for those with mental illness in New Mexico."
Elaine LeVine, chairman of the New Mexico Psychological Association's Task Force on Prescriptive Authority, said psychologists who want to prescribe drugs will get plenty of training.
She said a program at New Mexico State University offers licensed, doctoral-level psychologists the same training as non-M.D.s who are allowed to prescribe drugs in New Mexico - nurse practitioners, psychiatric nurses, physician assistants, podiatrists, dentists, clinical pharmacists, optometrists and clinical nurse specialists.
The 2001 bill called for a 300-hour special curriculum in anatomy, physiology, psychopharmacology and other disciplines for prescribing psychologists. The 2002 version ups that to 450 hours, LeVine said.
"We absolutely want to be safe prescribers," she said. "We're in this to help people."
LeVine said mental health care is lacking in rural parts of the state because of a shortage of psychiatrists and that psychologists can help that situation.
"The crisis in mental health care for rural and poor New Mexicans is particularly severe," she said. "They have several obstacles to obtaining quality mental health care, including limited access, a shortage of mental health professionals and poverty. There are people who are not receiving medications that could help relieve their emotional suffering and enable them to live more normal lives."
She said her group's research shows there are 19 psychiatrists living outside Albuquerque and Santa Fe, and 176 psychologists living outside those cities. Arnet said he believes the number of psychiatrists living outside the cities is closer to 60. He said most psychologists, like psychiatrists, live in bigger cities. He said the University of New Mexico and state Department of Health are working to get more psychiatrists into rural areas.
"This increases access and quality of care," LeVine said of the legislation. "There will be more of us to provide mental health treatment. And it tightens up the relationship between psychologists and primary care physicians. It's an interdisciplinary approach to treatment."
The New Mexico Medical Society does not believe psychologists should be allowed to prescribe drugs but agreed to work with the New Mexico Psychological Association on amendments to the bill when it became apparent it was going to pass the Legislature, said Randy Marshall, the society's executive director.
He said it was agreed the New Mexico Board of Medical Examiners would work with the Board of Psychologist Examiners to implement agreements. The two boards would determine curriculum, examinations, supervision, peer review and collaborative relationships, he said.
"We agreed to these amendments. We did not agree that psychologists should prescribe," he said. "Psychologists, with their education and background in behavioral health, don't have a scientific background in anatomy and physiology. We felt other allied professionals allowed to prescribe pharmaceuticals have extensive science in their education.
"But we feel more comfortable ensuring patient safety if the Board of Medical Examiners can work with the psychological board to increase curriculum needs and ensure the exam shows proficiency."
Arnet said that, unlike nurses, physician assistants, optometrists and other non-M.D.s, psychologists do not have a background in medicine.
LeVine said psychologists do have a background in biology "even though our training didn't come from medical school."
"They give us no credit for any past experience," she said. "That's absolutely ridiculous."
LeVine said 12 psychologists are well into the course work at NMSU and another 12 are beginning. She said 10 more have expressed interesting in starting the program since the legislation passed.
"It is clear that this level of expertise, previously held only by physicians, is being taught to other professionals, and that prescribing psychologists can be safe and effective prescribers of medications," LeVine said. "Our state can only benefit from such an expansion of services to our highly underserved populations, which include the poor, elderly and children in urban settings."
She said she hopes the success of the psychologists' effort in New Mexico will encourage other states to pass such legislation. Eight other states had been working on changing laws, she said.
"We hope this will help," she said.
Hi nightingale. It will be interesting to see how this will turn out. Do you know if psychologists take the same core classes as physicians, nurses, PA, podiatrists, etc? I understand that there is an acute shortage of mental health professionals especially in the rural and urban areas. But as far as prescribing medications are concerned, there are a fair number of physicians who haven't gotten it right. There are physicians that will also tell you that they are sometimes influenced by their patients wishes or a drug rep when it comes to prescribing meds. This does not always have positive outcomes.
My point is that until proven otherwise, I'm a bit more skeptical of this setup than I am with giving prescribing authority to NPs, PAs, podiatrists, dentists, and so on. What I see happening is that more -ologies will insist on having more authority in areas where they require a greater and longer learning curve. For instance, there's a shortage of those specializing in geriatrics and gerontology. Why not allow them to prescribe in a limited manner?
I can not say that I am in "the know". I no longer live in NM and am not in the Mental Health field myself.
I have as many questions as you and will watch with interest how this proceeds and look for the information as it is made available.
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