Letters to the Editor
Re: Should Psychologists Be Granted Prescription Privileges? A Review of the Prescription Privilege Debate for Psychiatrists
According to its objective, the article by Lavoie and Fleet is “informational” (1). However, while cogently written with regard to some pivotal events in psychology’s developmental history, it also contains some flagrant inaccuracies.
The authors allege that the clinical psychological subspecialty of clinical psychopharmacology is currently undeveloped, restricted to the prescription of psychotropic drugs (rather than also encompassing other medicines and the provision of medical care in general), and deviates from psychology’s theoretical approach to mental illness.
On the contrary, the specialty’s development has progressed substantially: the American Psychological Association has established strict standards for the psychopharmacological and medical education and training of psychologists, and this has been followed by the establishment of similar North American guidelines published by the Association of State and Provincial Psychology Boards (2). Further, a postdoctoral education and training program, along with a credentialling body (that is, the International Collee of Prescribing Psychologists [ICPP]), has been established to board certify psychologists in the medical evaluation and management of serious mental illness and related medical disorders (for example, hypothyroidism- induced depression, side effects of drugs, and adverse drug interactions), consistent with psychology’s theoretical approach to mental illness (3). Psychiatrist board members consistently note that the pharmacologic training of their student psychologists surpasses training provided within traditional medical schools, and legislation has been passed to allow duly qualified psychologists to prescribe medicine in US federal hospitals, in the US territory of Guam, and most recently, in New Mexico. In the case of New Mexico, after all the evidence both for and against was reviewed, legislation that consigned autonomous prescribing authority to duly qualified psychologists passed with a vast majority of favourable votes and with the support of both the New Mexico Medical Association and a psychiatrist who provided expert medical testimony. In Canada, the province of Alberta has reportedly modified its health care legislation to allow duly qualified health care professionals to request prescribing authority.
In sum, clinical psychopharmacology is a well-established clinical psychological subspecialty (and hence, well past the “debating” stage of development) with a wealth of data from both psychiatrists and psychologists documenting the qualifications of practitioners within this specialty to prescribe medicine competently and safely. Psychiatrists should question why 2 psychologists, neither of whom is board certified to practice this specialty, are attempting to “stimulate the interest” of psychiatrists and to “educate” them so that they may become involved in this discussion—a discussion about whether duly qualified specialists within another discipline should be allowed to provide health care services within their scope of practice.
1. Lavoie KL, Fleet RP. Should psychologists be granted prescription privileges? A review of the prescription privilege debate for psychiatrists. Can J Psychiatry 2002;47:443–8.
2. Melnyk WT, Allen MF, Nutt RL, Connor T, Robiner B, Pacht A. Guidelines for prescriptive authority. Montgomery (AL): ASPPB Committee on Education and Training for Credentialing, Association of State and Provincial Psychology Boards (ASPPB); July 2001.
3. Litman LC. Differences is prescribing practice between board-certified prescribing psychologists and psychiatrists. UWO Med J 2001;71(2):59–60.
Larry C Litman, PhD, Cpsych, FACAPP, FPPR, FSMI, FICPP, FSICPP