From: mdkline@rodan.acs.syr.edu (Mark D. Kline)
Newsgroups: sci.med
Subject: Re: [Prescription Privileges]
Date: 12 Sep 92 00:23:24 GMT
Distribution: na
Organization: Syracuse University

In article <88516@netnews.upenn.edu> zorrilla@cattell.psych.upenn.edu (Eric Zorrilla) writes:
>[hospital] Admission privileges have been granted to psychologists in
>DC and California and are likely to follow in domino-fashion throughout
>the nation.  What do mental health professionals out there see as the
>future of prescription privileges vis a vis clinical psychologists?
>
>	1)  Should an appropriately trained psychologist be granted
>limited prescription privileges of psychoactive medications?

In my opinion, No.  However, it is only a matter of time before such
privileges are granted.

>	2)  What would be the nature (breadth and depth) of that training?

Graduation from medical school and completion of postdoctoral
training.  The brain is part of the body.  It can't be medicated
without medicating the rest of the body.  Hypothyroidism can cause
depressive symptoms.  Are psychologists going to prescribe thyroid
hormone?

>	3)  Who would supervise it? (Which APA, for instance)
	
The Am Psychiatric Association doesn't have anything to do with
supervising or credentialing psychiatrists.  Its just a club.
Psychiatrists are certified by the American Board of Psychiatry &
Neurology and licensed to practice medicine in their respective
states.

>	4)  What would the licensing procedures entail (would there be an
>objective examination in addition to practica experience?)

What's wrong with licensure to practice medicine?  Should it really be
EASIER for psychologists to get credentialed to prescribe medications
than it is for MDs?  If you want to prescribe medication, why not be a
real doctor? :)

>	5)  To what degree should prescription privileges be "limited"
>	(only can prescribed antidepressants, but not anxiolytics, etc.)

This is the crux of the problem.  Patients are not going to be well
served by people with limited prescribing power.  How about beta
blockers, cardiovasculars which can be helpful in some anxiety
disorders, should psychologists prescribe them?  
And if the patient gets a drug rash and might benefit from steroids, 
is the psychologist going to prescribe that?   What if the patient's
antihypertensive medication is contributing to depression?
Is the psychologist going to do something about that?

I'm not concerned about the competition - there is plenty of 
mental illness to go around and there are not enough 
psychiatrists, imho.  I lecture frequently to primary care docs
about the appropriate use of psychotropics.  But family docs
and internists are physicians.  

I oppose the idea of psychologist's prescribing.  Many psychologists
do too.  The push to get prescribing privileges seems to me almost an
admission of impotence on the part of some psychologists.  In our town,
psychologists have been effectively admitting their private patients to
the psychiatric ward for years, essentially functioning as "the attending"
on the psych unit while a psychiatrist provided "medical coverage."
It can work.  None of the economically or clinically sucessful psychologists
I know favor prescribing privileges.  But, I have no doubt that it is only
a matter of time before such privileges are granted.


--
================================================================= 
mark kline                              mdkline@rodan.acs.syr.edu
suny health science center, syracuse    voice: (315) 422-1050
================ courtesy of syracuse university ================