April 2002 • Volume 8 • Number 4 |
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New Mexico psychologists gain prescribing privileges
Citing the need to increase access to mental health care for rural populations, New Mexico Gov. Gary Johnson signed legislation March 6 authorizing Ph.D.-trained psychologists to prescribe psychotropic drugs to patients. It's the first time a state has authorized this expanded scope of practice for psychologists.
However, a psychologist first must complete 450 hours of additional training and a two-year patient practicum under physician supervision, pass a national certification exam, and maintain a collaborative relationship with the patient's physician.
The American Psychiatric Association and the New Mexico AFP urged the governor to veto the bill. Daniel Derksen, M.D., a member of the NMAFP Board of Directors, paid Johnson a last-minute visit to lobby against the bill.
In addition, FPs sent the governor nearly 300 letters opposing the bill, Derksen said. However, it was signed into law because Johnson said he was "satisfied there were sufficient safeguards in the bill to protect state residents."
The American Psychological Association stated that 72 percent of New Mexicans live outside of Albuquerque and Santa Fe, and only 18 psychiatrists serve the rural population. The New Mexico Psychological Association reported that 176 members serve the same population. Practicing family physicians in these rural areas number 246, according to the 2002-2003 Physician Characteristics and Distribution in the U.S. report issued by the AMA.
"The reality is that family physicians already do the vast majority of prescribing in mental health cases in this state," said AAFP Director Arlene Brown, M.D., of Ruidoso, N.M. "So we, as physicians, need to do a better job at documenting the extent to which we are capable and willing to provide mental health care services."
American Psychiatric Association President Richard Harding, M.D., called the prescribing law "bad medicine for patients." "We believe that the legislature and the governor in New Mexico have placed patient health and safety at risk," he said.
Rick Kellerman, M.D., of Wichita, Kan., chair of the Academy's Commission on Legislation and Governmental Affairs, agreed. "This clearly will further fragment the care of an individual patient," he said, "especially for those of us who are trying to manage a patient's total care.
"If we're really going to increase mental health care access, this plan just missed the boat. Because access already is there with trained family physicians."
Brown sees the prescribing law as the result of a push by the national psychological organization to "get it on the books somewhere" and to advocate this expanded scope of practice elsewhere in the country.
"There are very few psychologists in the state who actually want to pursue it," she said. "Many of them lobbied against the bill, saying they didn't want the responsibility or liability of prescribing drugs."
"I see this as a very limited experiment that eventually will die a natural death," Brown added.
However, in anticipation of the bill's approval, a curriculum designed to satisfy the educational requirements is available at New Mexico State University in Las Cruces. About 20 psychologists are enrolled in the program, said a representative of the state psychological group's task force on prescriptive authority.
Kellerman said the Academy would continue to monitor the situation and provide support if similar legislation emerges in other states.
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Copyright © 2002 by
American Academy of Family Physicians.