Prescriptive authority and psychology: A status report.

Abstract

The progress of psychology toward the acquisition of prescriptive authority is critically reviewed. Advances made by other nonphysician health care professions toward expanding their scopes of practice to include prescriptive authority are compared with gains made by professional psychology. Societal trends affecting attitudes toward the use of psychotropic medications are reviewed, and the potential influence of such trends on the prescriptive authority movement is examined. A history of the prescriptive authority movement is documented, and recent legislative and policy initiatives are discussed.

What Oregon Psychologists Think and Know About Prescriptive Authority: Divided Views and Data‐Driven Change

“…Additionally, few Oregon psychologists expressed an interest in pursuing training to become prescribers; in fact, results support prior survey results of both Oregon (Campbell et al., ) and Illinois (Baird, ) psychologists in suggesting that few have an interest in pursuing training and even fewer plan to prescribe. Strong proponents of RxP themselves acknowledge that “… among practitioners, the notion of prescriptive authority is not universally embraced, and indeed only a minority of practitioners has evinced interest in seeking the ability to prescribe” (Fox et al., , p. 257). With so few psychologists interested in pursuing training and demographic data which demonstrate similar distribution patterns for psychologists and psychiatrists, RxP proponents’ claims of improved access seem to be lacking empirical support.…”

“…Proposals by the initial APA task force (Smyer et al., ) and the Psychopharmacology Demonstration Project (PDP; American College of Neuropsychopharmacology, ) recommended that trainees possess a strong science background consonant with what is required of other non‐physician prescribers who can independently prescribe. It is perplexing that proponents openly acknowledge these reduced standards, “… psychology has the core curriculum with probably the least overlap with traditional medical curricula” (Fox et al., , p. 258), whereas surveys suggest that psychologists believe that in order to competently prescribe, their knowledge and training should be equivalent with that of other prescribers (Baird, ; Grandin & Blackmore, ).…”

“…When opponents have asked for data to support such claims about practice patterns and safety, it is not forthcoming. It seems particularly surprising that so many prescriptions could be provided “without incident” (Fox et al., , p. 264), as proponents claim, given the rates of significant adverse effects associated with psychoactive medications, some of which are extreme. For example, both conventional and atypical antipsychotics are associated with very concerning mortality rates in older adults typically within several months of initiating a medication trial (Kales et al., ; Wang et al., ).…”

Is Gerontology Ready for Accreditation?

“…For example, there have been substantial efforts over the past 20 years to allow clinical psychologists to gain authority to prescribe psychotropic medications. These efforts, and related efforts by professions such as nurse practitioners, have been repeatedly opposed by physician groups such as the American Medical Association and the American College of Physicians (Fox et al, 2008).…”

Psychologists and medications in the era of interprofessional care: Collaboration is less problematic and costly than prescribing.

“…Fox et al (2009) estimated that at least 88 RxP legislative initiatives had been introduced in 21 jurisdictions. Using a somewhat different methodology that counts specific bills, we estimate that 170 initiatives to authorize psychologist prescribing have been introduced in about half of the U.S. states and two territories.…”