How has the IPA Council tried to balance competing opinions about RxP?

During the last five years of IPA Council Meetings, there have been several votes on RxP activities and all of these Council votes have included thorough discussions of this complex issue with consideration of minority and majority Council and member opinions. Each of these votes affirmed the IPA’s engagement in RxP lobbying activities. During the last year, as noted above, RxP votes had been taken at the January 2011, September 2011, and January 2012 meetings. At every one of these votes the RxP initiative had been confirmed nearly unanimously with at times one abstention. There were no negative votes.

Is the IPA RxP Initiative new or sudden in its process?

The RxP Subcommittee of the IPA Legislative Committee was established in 1991 with the express purpose of pursuing prescriptive authority for psychologists with APA approved specialized training in clinical psychopharmacology. IPA first introduced a prescriptive authority bill in 1998 with state Senator Carol Ronen as our chief sponsor. This RxP initiative has been routinely discussed in association meetings or forums that are open to all members. Since 1991 prescription privileges for psychologists in Illinois has been discussed and designated as an active agenda item with the membership of IPA and publicly on numerous and regular occasions. IPA elected officers and section chairs have followed specific IPA policies regarding IPA activities on prescription privileges just as it follows these specific processes for other action items. The issue of prescription privileges has been regularly discussed at monthly Legislative Committee meetings. These meetings are open to any IPA member and the times and dates of these monthly open meetings are posted in every issue of the IPA quarterly Newsletter. Since 2006, the issue of prescription privileges has been the subject of at least one article in every newsletter except for 2 of the last 19 issues of the Illinois Psychologist and has been discussed at every Legislative Committee meeting in all but 2 Council meetings. We know that IPA Area Code Representatives have discussed RxP with their constituents in both formal and informal meetings. From January 2011 through the present, the RxP legislative initiative has been discussed at every Council meeting (January 22, 2011, April 16, 2011, June 18, 2011, September 17, 2011, and January 21, 2012). At the January 2011, the September 2011, and the January 2012 meetings votes had been taken on this initiative. At every one of these votes, the RxP initiative had been confirmed nearly unanimously with, at times one abstention or, at other times, two abstentions. There were no negative votes. Moreover, in every IPA Newsletter, an RxP Committee is shown as an official Committee of the Association.

Will there be other opportunities to discuss IPA’s RxP Initiative?

Elected IPA leadership does its best to communicate to the membership through specific processes. Items for discussion and action are first discussed in committee meetings, which anyone can attend. Committees then present any actionable items to Council where issues are discussed, debated and ultimately put to vote at quarterly Council meetings. The results of such votes and approved action items are then communicated to the entire membership in the member newsletter.

We invite all of you to our legislative update session and our all-Association meeting at the 2012 Annual Convention November 1st through 3rd. While the legislative update sessions at Convention are typically standing-room only events, our all-Association meetings tend to be less well attended. Please do consider attending both of these meetings a priority.

The State of Prescribing Psychology in Illinois

Woman with Folder

More than 500 psychologists have completed training to become prescribing clinical psychologists nationally. In Illinois, there are currently 13 licensed prescribing psychologists as of June 2022, with several more slated to become licensed in 2022.

Prescribing psychologists in Illinois are required to have a doctoral degree (PsyD/PhD) in clinical psychology and a master’s degree in clinical psychopharmacology (most often a Master of Science in clinical psychology [MSCP]) from an APA-designated training program. In addition to this master’s degree in clinical psychopharmacology, they must complete undergraduate biomedical coursework, such as medical terminology, biology, general chemistry, microbiology, and human anatomy & physiology. Prescribing psychologists are also required to pass a national, standardized exam, the Psychopharmacology Exam for Psychologists (PEP), which is administered and maintained by the Association of State and Provincial Psychology Boards (ASPPB). The final requirement is successful completion of a prescribing psychology residency consisting of 9 medical rotations (family medicine, internal medicine, psychiatry, pediatrics, geriatrics, obstetrics/gynecology, emergency medicine, surgery, and one elective) over the course of at least 14 months and not more than 28 months. These rotations must total at least 1,620 hours and each resident must accumulate at least 20 hours per week while undertaking this residency. There are currently five APA-designated programs of study in clinical psychopharmacology: The California School of Professional Psychology at Alliant International University, Fairleigh Dickinson University, New Mexico State University, Idaho State University, and The Chicago School of Professional Psychology.

There are also institutions in the state of Illinois that offer pre-prescribing psychology undergraduate majors, such as the University of Illinois at Urbana-Champaign. Southern Illinois University at Carbondale is also developing this undergraduate major.

Prescriptive Authority for Psychologists . . .

What is being proposed — and why?

Why are Illinois psychologists pursuing prescription privileges?
1. To make appropriate medications available to underserved populations;

2. To give patients the option of a broader continuity of care from their psychologists 3. To enhance psychologists’ expertise in and knowledge of brain-behavior relationships.

Would any licensed psychologist be eligible to prescribe?
Absolutely NOT — no responsible licensed clinical psychologist recommends this. What is being proposed is that persons who are already licensed clinical psychologists would complete additional didactic and clinical training and pass a rigorous exam before being certified to prescribe. Illinois psychologists are asking that psychologists licensed to prescribe offer only psychoactive and ancillary medications.

Can psychologists be trained to prescribe with an appropriate level of safety without completing medical school, a psychiatric residency, and board certification?
Yes. Experts in psychopharmacology consulted by the American Psychological Association and independent evaluators who have reviewed the performance of those psychologists who have already been trained to prescribe have verified psychologists can prescribe safely. Additionally, the licensed clinical psychologists who have completed ADDITIONAL training offered by the Department of Defense Demonstration Project have been able to prescribe safely (see Cullen and Newman, 1997.)

There is also evidence that other non-physician prescribers can do so with an appropriate level of safety.

Would all psychologists seek this additional certification?
NO — this proposed model of training would require an extensive commitment of time and energy. Surveys of licensed clinical psychologists who are in favor of prescriptive authority for specially trained and licensed psychologists indicate that only about twenty-five percent of psychologists would pursue this additional training at this time. However, it is hard to predict what would actually happen.

What, exactly, is being proposed?
1. First — become a licensed clinical psychologist.

Under this proposal, only licensed clinical psychologists would be eligible to enter this additional training. Many people are unaware of the requirements for training clinical psychologists. In the state of Illinois it is necessary to obtain a doctoral degree from a program in psychology that meets the following requirements:

Coursework:

Three years (if full-time) graduate course work covering the following seven content areas: biological basis of behavior; cognitive-affective basis of behavior; social basis of behavior; individual differences —theories of normal and abnormal personality functioning; assessment including clinical interviewing and the administration, scoring and interpretation of psychological tests; treatment modalities for mental, emotional, behavioral or nervous disorders; and ethics. The usual number of individual graduate level courses is between 18 and 27.

Clinical Training:

Practicum: 1500 hours (pre-doctoral)
Internship: one year full time ( pre-doctoral)
Post-doctoral: one year full time

Research Requirement:

Acceptance of a doctoral dissertation (Ph.D., Psy.D., Ed.D) or a doctoral clinical project (Psy.D.)

Examination:

Pass the state administered licensing examination

2. Next — the following is the additional training, which would be required to become a “psychologist licensed to prescribe.”

The proposed additional training includes course work, clinical training, and passing an examination.

Course work:

A graduate level course in each of the following areas neuroscience, pharmacology, psychopharmacology, physiology, pathophysiology, physical and laboratory assessment, and clinical pharmacotherapeutics.

Clinical training:

Shall include at least 400 hours of management of the pharmacological treatment of a minimum of 100 patients under the full supervision and control of a designated qualified practitioner. So far, the supervisors have almost all been board certified psychiatrists.

Examination:

Passing an examination prepared by experts in the field of psychopharmacology.

Why would a psychologist pursue this training now without a guarantee of being able to prescribe?
Although the reasons given for pursuing training vary, many of the licensed psychologists undergoing the training argue that the additional knowledge gained helps them work more effectively in collaboration with other providers including psychiatrists and other medical providers — making their assessment of a patient’s progress and reaction to all modes of treatment more cogent when asked for input by prescribing physicians and helping them understand their patients reactions to medication better. The scope of practice for licensed psychologists, in some states, includes making treatment recommendations regarding psychoactive medications to physicians, even though the psychologists themselves do not prescribe.

Some argue that the training satisfies a psychologist’s natural curiosity about this treatment modality, and some do not intend to obtain the actual prescribing authority themselves, but are motivated by a desire to understand neuropsychological functioning.

What is the likelihood that psychologists who are trained under this model will be allowed to prescribe?
Some psychologists do already prescribe in the military and Indian Health Service, while this expanding scope of practice is most likely to be seen in rural and remote areas of the United States first, because the need for additional providers there is most obvious. Psychologists in New Mexico, Louisiana and Guam with this training have been granted prescriptive authority. However, even in urban areas there remain large populations of persons who would benefit from this mode of treatment who are not now being served. Obviously, advocates for this new training and certification hope that the privilege will become more widespread and are working toward that end.

Military Prescribing Psychologists

An RxP Example

Soldier

The Department of Defense trained ten psychologists to prescribe psychotropic medication. Exhaustive evaluations of their practices have found that they “filled critical needs and performed with excellence wherever they served.” (U.S. General Accounting Office, 1999)

The links below will take you to interviews of these prescribing military psychologists as they describe how prescriptive authority has improved their ability to help patients without sacrificing any of the traditional psychological tools that are so important to mental health treatment.

Information for the Public

Family

Many people who have come to rely on clinical psychologists for psychological services would prefer to have the doctor who knows them best manage their mental health medications. Some have expressed concern that it is more costly and time consuming to have to meet with two different doctors.

If you would like to express your desire to make it possible for your psychologist to manage your mental health medication, you can send a letter or email to your Illinois Senator and Representative easily by clicking on the link below.