Should Psychologists Prescribe?

Question 1

What are the prescription privileges in the USA?

Answer 1

1 - RxP in five states and in Guam
2 - psychologists with Public Health Service
3 - psychologists with Indian Health Service
4 - psychologists in Army, Navy, Air Force, Coast Guard

Question 2

What are the 3 APA-Designated Levels of Training?

Answer 2

1 - Basic Psychomarmacology Education: survey course in psychopharmacology
2 - Collaborative Practice (Consultation-liaison model): psychopharmacology focus in the internship, on-the-job training, consultation and supervision by psychiatrists
3 - Prescription Privilege: instruction in bio, safety, ethics and competency exam as well as 400+ hours of supervised patient contact

Question 3

Why do psychologists still not have RxP in Canada?

Answer 3

1 - division in the field between research and practice
2 - only minority of psychologists want RxP
3 - concern with overuse of drugs instead of therapy
4 - difference between psychology and medical training

Question 4

What are the arguments for RxP in Canada?

Answer 4

1 - quality of care
2 - access to services
3 - patient safety
4 - fits with the science of psychology
5 - would make psychology more unique, not less
6 - future relevance of the profession
7 - not driven by self-interest
8 - probably wouldn’t increase susceptibility to advertising strategies

Question 5

What are the main points for the argument that RxP would increase quality of care?

Answer 5

1 - therapy + drugs = better outcomes
2 - RxP would be easier and more efficient in a field where few practitioners are available to do both
3 - psychologists could provide more accurate assessments and conservative prescription (psycho-behavioural model rather than disease model)

Question 6

What are the main arguments that RxP would increase access to services?

Answer 6

1 - patients lack access to psychiatrists and must see under-trained GPs for drugs
2 - lack of insurance coverage restricts access to psychologists, which RxP might get coverage for
3 - psychologists could help fill the gap where underserved areas lack specialists

Question 7

What are the main points for the argument that RxP would support patient safety?

Answer 7

1 - as of 2010, no disciplinary actions have been taken against RxP in the USA
2 - the most comprehensive study of the PDP (Psychopharmacology Demonstration Project) by US DoD found that RxP graduates were medically safe and filled critical needs, performing with excellence
3 - other non-physicians safely provide drugs

Question 8

What are the main points for the argument that RxP fits well within the science of psychology?

Answer 8

1 - agreement in literature (biopsychosocial model)
2 - biological aspects of RxP well within scope of training
3 - more than 10 years of training at the post-doctoral level, so good understanding of biol/psycho/social factors
4 - would not be a completely unrelated model of training

Question 9

What are the main points of the argument that RxP would support Psychology’s identity?

Answer 9

1 - integrated service
2 - biological orientation
3 - would make psychology more unique (not less)

Question 10

What are the main points of the argument that RxP would make psychology more relevant in the future?

Answer 10

1 - would combat the perceived marginalization of psychologists in the public sector (hospitals cutting psych jobs, masters-level practitioners replacing PhD’s)
2 - expanding scope of practice will increase the demand for services

Question 11

What is the main point for the argument that desire for RxP is not driven by self interest?

Answer 11

Those who opposes RxP say there is the desire for: parity with psychiatrists, enhanced status, higher income.

Davis et al (2016) found that self-interest did not predict attitudes on 6 question survey of 211 psychologists.

Social norms were a stronger predictor - psychologists more likely to support RxP if they believed their colleagues did

Question 12

What are the main points to the argument that RxP would not affect professional ethics through advertising?

Answer 12

1 - current psychologists are conservative in their use of medication for treatment
2 - too few practitioners to attract pharmaceutical companies
3 - psychologists already contend with marketing influences, so RxP would not change things significantly

Question 13

What are the main arguments against RxP

Answer 13

1 - RxP would shift psychology’s level of analysis
2 - will change psychology’s identity
3 - will not increase access to services
4 - cannot guarantee patient safety
5 - may be insurmountable regulatory/legal issues
6 - could deteriorate professional ethics
7 - could reduce quality of care and marketability

Question 14

What are the main points of the argument that RxP would shift psychology’s level of analysis?

Answer 14

1 - RxP does not fit well with the psychological model (behavioural-environmental)
2 - would shift analysis from the mental to the biological

Question 15

What are the main points for the argument that RxP would change psychology’s identity?

Answer 15

1 - would have to sacrifice proficiency in psychosocial approaches to master the medical aspect of RxP
2 - psychiatry has become more medical over the years, won’t psychology go that way too?

Question 16

What are the main points of the argument that RxP would not increase access to services?

Answer 16

1 - there is a shortage of both psychologists and psychiatrists, and demand in rural areas may not be met by either profession since RxP would add years of training for psychologists

2 - RxP might lead other profession to infringe on the therapy aspect of psychology’s territory

3 - using other professionals’ lack of training to support the training of psychologists is unprofessional

Question 17

What are the main points for the argument that RxP cannot ensure patient safety?

Answer 17

1 - the results of the PDP might not generalize to civilian sectors, since it is difficult to replicate the DoD’s quality of supervision and training

2 - how do we even know when there’s been enough training to ensure patient safety?

Question 18

What are the main points for the argument that RxP could introduce regulatory/legal complications?

Answer 18

1 - RxP might increase difficulty of licensure
2 - there is currently no agreed upon accreditation process for RxP
3 - even a few malpractice suits could cause insurance to become more expensive
4 - potential problems with creating licensing boards to regulate the profession with RxP

Question 19

What are the main points for the argument that RxP could affect professional ethics negatively?

Answer 19

1 - new ethical issues to navigate
2 - could be influenced by pharmaceutical marketing practices
3 - integrity could be undermined by influences and biases
4 - Canada’ health care system different from the USA and doesn’t have the same monetary/disciplinary motivation for adding RxP to psychologists’ training

Question 20

What are the main points for the argument that RxP might diminish patient quality of care?

Answer 20

1 - RxP would dilute psychological services (patients might attribute improvement to drugs rather than therapy)
2 - might undermine the positive public views of psychologists as distinct from psychiatrists