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:
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.
Practicum: 1500 hours (pre-doctoral)
Internship: one year full time ( pre-doctoral)
Post-doctoral: one year full time
Acceptance of a doctoral dissertation (Ph.D., Psy.D., Ed.D) or a doctoral clinical project (Psy.D.)
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.
A graduate level course in each of the following areas neuroscience, pharmacology, psychopharmacology, physiology, pathophysiology, physical and laboratory assessment, and clinical pharmacotherapeutics.
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.
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.