No one even returns my calls… No one takes my insurance… Everyone I call has no openings.
These are the phrases I hear from my patients, friends, and family who are trying to find psychiatric medications for a behavioral health or substance abuse concern.
My office manager recently tried to find services for her daughter; she called 19 psychiatrists without one return call.
Why?
Maybe they’re too busy; maybe they’re full; maybe they don’t accept that person’s health insurance.
Our psychiatric colleagues might argue that there are enough psychiatrists and APRNs to meet the behavioral health and addiction prescribing needs of Connecticut’s residents, but that’s not what reality shows. Our office receives numerous daily calls from frustrated patients who cannot find a prescriber, and who do not want to have two providers: one for medication and one for psychotherapy.
Prescribing psychologists are an additional option to fill that gap in needed services. Appropriately medically trained psychologists can help fill needed services for prescribing psychiatric medications for Connecticut’s citizens while also providing evaluation, and psychotherapy that we already do. Psychopharmacology training for psychologists involves a rigorous medical program designed for practicing doctoral psychologists, similar to many APRN programs. It is a two-year, cutting-edge and comprehensive master’s program in biomedical science, clinical medicine, neuroscience, and psychopharmacology, including comprehensive exams, supervised clinical experience, followed by a national board exam.
Here is why psychologists should be allowed to prescribe:
There is a clear shortage of psychiatric medication providers in Connecticut, which causes long waits or difficulty to the point of giving up. When facing a behavioral health or addiction issue, patients and family members don’t need to face roadblocks to the care they need. The situation is often worse for children and adolescents.
In many cases, primary care providers try to fill the gap; some estimates show as much as 80 percent of the psychiatric medications prescribed are by primary care doctors, nurses, and physician’s assistants, but these providers are often not keen on prescribing these drugs, lack specific training, and many are unfamiliar with the complexity and interactions of these drugs in more complicated psychiatric situations.
Oftentimes, they’re not willing to prescribe as aggressively or as comprehensively as would be needed in a case of somebody requiring more complex care, and they don’t have the time to devote to doing the psychiatric history and psychotherapy needed. Psychologists do have and take the time, and studies show that prescribing psychologists (we have been safely prescribing in several states, the military, and federal government, for over 20 years) spend more time, prescribe less medications, and are more likely to take a patient off unneeded medications.
It’s an incontrovertible fact that we have a substance-abuse and opioid epidemic. As an addiction medicine specialist, I have treated addictions for much of my career. There are numerous medications used in medically assisted therapy for the treatment of addictions, the most popular perhaps being Suboxone, but unfortunately only 5 percent of psychiatrists in Connecticut prescribe Suboxone. This is a life-saving drug and can reduce the morbidity and mortality of opiate addiction by 50 percent if used appropriately. With prescriptive authority and appropriate additional training, psychologists could be added to this list.
The fact is psychologists can and do prescribe medications without issue. That leaves the why shouldn’t we in Connecticut?
Our psychiatric colleagues and advance practice psychiatric nurses don’t seem to want us to prescribe here in Connecticut, even though our patients and the public is largely in favor of it. Despite the data that clearly shows we can and do prescribe safely, why would they not welcome more well-trained colleagues to help with Connecticut’s behavioral health and addiction crisis?
They may argue inadequate training or safety concerns, but the scientific support for this is not there. Prescribing psychologists are trained comprehensively, though differently than our colleagues. On March 25 the Connecticut legislature held a public hearing for SB 966-An Act Concerning the Prescriptive Authority of Psychologists. This bill will enable appropriately medically trained psychologists to prescribe medications for the treatment of behavioral health, psychiatric, and substance use problems.
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David Greenfield of West Hartford is a psychologist and specialist in addictive medicine.
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Interesting article. Just out of curiosity, do prescribing psychologists charge more than non-prescribing psychologists? This also runs contrary an excellent article available on the American Psychological Association’s website https://www.apa.org/monitor/2012/06/prescribing. Why on earth would a psychologist want to be more like a psychiatrist other than money? Psychiatrists are more dangerous than drug dealers because people trust them and take prescription meds that do far more harm than good at least in the long term.
Perhaps the most disturbing thing about this article is the attack on primary care physicians who you declare are often “unfamiliar with the complexity and interactions of these drugs in more complicated psychiatric situations.” Here, you’re talking about prescribing multiple meds and the wonderful world of psychiatric polypharmacy. To be clear, absolutely no one knows whether prescribing a psychiatric medication will help. This is especially true as the number of psychiatric meds are increased since these meds are not tested and approved in conjunction with each other and no single psychiatrist treats a sample size of patients taking multiple psychiatric meds to reliably determine that the combination is efficacious and safe. And why is it that primary care physicians are as you state often reluctant to prescribe psychiatric medications? Perhaps because they’re dangerous and it opens them up to medical malpractice liability.
Well, it’s true that primary care physicians likely do not engage in psychotherapy, but then again, neither do most psychiatrists these days. It’s worse when they try because their goal is to treat the patient with horrific meds. It’s much safer talking to someone about extremely private and emotional subject matter when the person listening is thinking about how to help them LEARN to think and act differently or perhaps modify their environment to alleviate their problems. The idea of psychologists prescribing meds to treat symptoms instead of eliminating the root cause of the problem is disgusting.