Imagine this scenario. You are the CEO of a major airline that has a problem with flights being delayed. You could solve the problem by hiring pilots who have thousands of fewer hours in a cockpit than the commercial industry standard. Knowing that there are other solutions, would you risk your customers’ safety by recruiting these less experienced pilots?
If House Bill 23-1071 passes this legislative session, a similar risk would be faced by thousands of Coloradans who suffer from psychiatric illness. Instead of a psychiatrist, primary care doctor, or a psychiatric nurse practitioner, a psychologist — a non-physician with minimal training in medicine and prescribing — could prescribe medications to patients.
The Colorado Psychiatric Society opposes the measure for the following reasons:
Psychologists are not medical practitioners
Although doctoral level psychologists are highly educated, their coursework focuses on behavior and emotions, not medicines or the human body. The Colorado General Assembly is considering granting prescriptive authority to psychologists who have completed what equates to only the first four months of a first-year medical student’s education, or about 400 hours. In comparison, 2,500 hours of training are required for psychiatric nurse practitioners and 16,000 hours are required for psychiatrists during their four years of residency training after graduating medical school.
Psychiatric symptoms are frequently caused by disorders of other organs and psychiatric medications affect the whole body
Coloradans with psychiatric illness deserve to be evaluated and treated by professionals who have comprehensive medical knowledge and are proficient in diagnosing and treating illness. Sometimes physical illness presents with psychiatric symptoms. Being able to distinguish between physical and psychological causes of psychiatric symptoms is crucial to ensuring that patients receive appropriate treatment.
In addition, medications prescribed for psychiatric illness impact not only the brain but the entire body. Stringent monitoring is required to evaluate the effects and side effects of many psychotropic medications. Drugs can have dangerous consequences if they are improperly prescribed. Of the 30 most prescribed medications for psychiatric illness, 18 carry black box warnings (the FDA’s most serious warning of potential side effects). It is imperative that prescribers be proficient in diagnosing and treating side effects.
Psychologists prescribing will not improve access to care
Since the first psychologist prescribing bill passed in New Mexico in 2002, it was expected that access to care would improve. This has not been shown to be the case. In 20 years of psychologists prescribing laws across five states, there are fewer than 250 prescribing psychologists in the entire nation. In addition, the vast majority of individuals who struggle most to access psychiatric care are on federal programs. Medicare, the largest payer in the country, does not reimburse prescribing psychologists, citing concerns that they aren’t adequately qualified to prescribe medication.
So what’s the solution?
Colorado is already investing in solutions that expand access to care without compromising patient safety. Last year, state lawmakers voted to dedicate Federal American Rescue Plan funds to increase telehealth services and help establish and fund consultation support programs and improve access to school-based clinics. These funds are also being used to set up collaborative care programs in which patients are identified and treated in primary care offices. Collaborative Care is a force-multiplier that utilizes healthcare workers who are already available and trained to do the work.
When there are safer solutions that improve access to care, HB 23-1071 is unnecessary in addition to being dangerous. It is too much of a risk to put our family members, loved ones and neighbors in the care of prescribers with inadequate knowledge and training. As a psychiatrist who has been in practice for more than 20 years, I have no question that my patients deserve more than that.
Patricia Westmoreland, M.D., of Denver, is a general adult/forensic psychiatrist, psychiatry residency training director and chair of the Colorado Psychiatric Society Legislative Committee.
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