Psychiatric doctors all across Wisconsin have begun to sound the alarm along the watch towers of the medical industry.
The Wisconsin Psychiatric Association (WPA) is sounding off a warning to the public calling attention to an effort by psychologists seeking to pass Senate Bill 180 (SB180). The bill, according to WPA, authorizes the Wisconsin Psychology Examining Board in the Department of Regulation and Licensing to issue a certificate of “prescriptive authority” to a licensed psychologist who has completed educational requirements and supervised practice established by the board.
“Prescriptive authority” is defined to mean authority to prescribe, distribute, and administer drugs to treat disorders identified within the practice of psychology. Psychiatrists, who go to medical school and train for years to become medical doctors, are labeling SB180 as dangerous. They say that allowing psychologists, who have no medical training, to prescribe psychiatric medications opens a Pandora’s Box to medical complications and safety concerns.
Psychiatric medicines are one of the most complex in medical treatment and carry many side effects. All physicians do extensive training in physiology, anatomy, biochemistry, and years of clinical hospital and outpatient clerkships to learn how to prescribe and manage medications. In addition, psychiatrists must do 4 to 5 more years of clinical training on top of their already rigorous medical training to specifically learn and apply medications pertaining to mental illness. According to Dr. Selahattin Kurter, M.D., Board Certified psychiatrist and one of a few doctors in
Dr. Kurter points out that a physician and or nurse practitioner are the only people trained to manage these medications so that the risk to patients and the general public can be minimized. “Psychiatrists are experts in mental health medications for a reason--they have been trained to do so," Kurter said. "Many family physicians and internists will defer to psychiatrists for psychiatric medication management due to complexity and potential medication interactions.
The WPA believes that the passage of this bill will set up a substandard and dangerous care system for the mentally ill. Dr. Kurter says that most other states in the
I say, let’s support WPA’s call to have the state reject SB180. The increase in the amount of financial and medical liability to allow psychologists to prescribe medication for the mentally ill would be a hard pill to swallow for all
Robert Miranda is a Latino community activist, editor-in-chief of the Milwaukee Spanish Journal and executive director of Esperanza Unida Inc. in Milwaukee.
Milwaukee Biz Blog
A pill of a bill
Posted on April 30, 2009 10:05 AM
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6 Comments
Robert is 100% right. As the son for a former medical school professor, and having worked in the mental health field for 10 years, myself, I can only concur with his statements. This isn't like letting a specially trained physicians assistant or nurse practitioner prescribe medications. It would be a serious mistake to let SB180 pass. I join Robert in his call to reject this legislation. Contact your State Senator soon and urge him/her to reject SB180.
This sounds like a case of campaign contributions begetting favorable legislation. I'm willing to bet the politicians that are proposing this bill have been purchased by a group representing psychologists. Where is Mike McCabe and his Wisconsin Democracy Campaign? Where is our supposed watchdog press? Is this what they call crony capitalism? I may be off base, but I'm curious.
This blog misrepresents the proposed legislation and the training of psychologists who would be permitted to prescribe under it. First, during a psychologist's 5-8 years of post-Bachelor's education, we receive a great deal of training in biology, neuropsychology, and related matters. In addition, the legislation requires at least two years of formal education in pharmacology, physiology, and related areas. The U.S. Department of Defense has had psychologists prescribing psychotropic medication for decades, and Louisiana and New Mexico, if memory serves me right, also permit psychologists to prescribe. In Wisconsin, getting an appointment with a psychiatrist in an urban area can take a month or more -- there are not enough to serve the need even in these areas. Even more urgent, around 20 counties have no psychiatrists, but every county does have psychologists. The mental health care of Wisconsinites requires adequate access to highly-trained, doctoral-level mental health practitioners. In much of the state, adequate mental health care requires that rigorously-trained psychologists be permitted to prescribe psychotropic medications.
Andrew W. Kane, Ph.D.
Dear Robert,
Yesterday's blog did a good job of presenting one side of this debate, that of the Wisconsin Psychiatric Association. I think your readers deserve to be introduced to the rest of the story.
Senate Bill 180 would require experienced psychologists who already have PhDs to return to school to complete a Master's degree in Psychopharmacology, which is the study of how drugs affect the brain. This involves taking two years of courses in foundational sciences such as biochemistry, pathophysiology, and pharmacology-- similar to those taken by students training to become physicians, nurses, pharmacists, etc.
Following that, psychologists intending to become Prescribing Psychologists must pass a rigorous national competency exam, and then complete a minimum of one year's practice in prescribing while supervised by a physician.
You didn't mention that Prescribing Psychologists have practiced very successfully in all branches of the military since the early 1990's, and recently, the Indian Health Service and US Public Health Service have started recruiting them.
You also didn't mention that psychologists have been practicing in New Mexico since 2002 and Louisiana since 2004, with no known complaints registered with licensing boards, and no malpractice actions filed after an estimated 250,000 prescriptions.
Consequently, your comment that "the amount of financial and medical liability…would be a hard pill to swallow" is off the mark. The public should know that the American Psychological Association's own insurance trust provides malpractice insurance to all psychologists that prescribe, and that no state-based patient compensation funds are involved at all.
I am sure you are very well aware that minorities across our state have tremendous difficulty accessing psychiatric services. In our county mental health centers there is an average of 9 weeks wait for an initial appointment to see a psychiatrist. Nursing homes can't find psychiatrists willing to visit agitated dementia patients, and troubled prisoners are released with a week or two's supply of medications, with no provision for follow up.
Everyone that deals with the mental health system knows that there is a gross shortage of psychiatrists, and that the problem is only going to get worse.
For a lesson from history, you might look back at the arguments used to try to derail Advanced Practice Nurse Practitioners 15 years ago. The prophecies of doom and malpractice never materialized! Then, as well as now, the opposition was fueled more by turf protection than anything else.
Rather than "set up a substandard and dangerous care system for the mentally ill" as you assert, adding Prescribing Psychologists to the mix of psychiatric prescribers will actually give the mental health system a much-needed boost. Our impressive list of non-profit organizations in support of SB180 will attest to that!
Joe Marceil, Ph.D.
Prescriptive Authority Workgroup
Watertown, WI
It seems to me like Dr Kurter might as well have written this post. Nearly a third of the word count is his quotes, and a much of the rest merely paraphrases the WPA position. By the way- which WPA? WPA is an acronym shared by the Wisconsin Psychiatric Association with the other party to this debate: the Wisconsin Psychological Association. There are two sides to this dialog, but only one side's arguments seem present in this post.
I totally support this article. Psychologists do not have the medical training necessary to prescribe these kinds of medications. I agree that more mental health resources should be allocated to those in need, however, risking the safety of those who are most in need is no answer. If Psychologist want to prescribe they should go to nursing school or medical school.