Education is all-important in health care. It guides complex decision-making, promotes cost-effective care and ensures patient safety. And patients know it too—more than 90% say a physician’s years of education and training are vital to optimal patient care.
Yet there are continuous efforts to inappropriately expand scope of practice for nonphysicians. Among these efforts are attempts to allow psychologists—whose doctoral-level education features no medical training at all—to prescribe many of the same powerful psychotropic drugs prescribed by psychiatrists and other physicians.
While six states allow psychologists to prescribe psychotropic drugs, lawmakers need to exercise extreme caution and keep the prescription pad out of the hands of inadequately trained health professionals.
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety.
More education is better
One of the most obvious things that distinguishes psychiatrists from psychologists is the length and depth of their training.
Doctors of psychology and doctors of philosophy in psychology—who earn PsyD degrees and PhDs, respectively—get four to six years of graduate-level education plus a one-year internship. But requirements and curriculum vary greatly by psychology program.
By contrast, psychiatrists complete four years of medical school—earning degrees as medical doctors, MDs, or doctors of osteopathic medicine, DOs—followed by four to six years of post-graduate training by way of a medical residency and, sometimes, fellowship. All of that is preceded by the four years it typically takes to earn a bachelor’s degree.
Moreover, psychologists complete a one-year internship while psychiatrists get between 12,000 and 16,000 hours of patient care during their four- to six-year residency program. And the difference in the type of patient care training they get is critical. While psychologists provide care for emotional and behavioral issues, they do not provide medical care while psychiatrists do.
“Throughout my career, I have proudly worked alongside psychologists and other nonphysician behavioral health clinicians to help take care of patients,” said Patrice A. Harris, MD, MA, a board-certified child and adolescent psychiatrist in Atlanta and former AMA president. “Psychologists play a valuable role in helping patients with their emotional, mental, and behavioral problems and providing interventions such as ‘talk therapy.’ But when it comes to safely and effectively prescribing psychotropic medications that can impact the whole body, the medical education and training that psychiatrists and other physicians receive has no peer.”
Learn more with the AMA about what sets apart physicians and nonphysicians.
Knowing the biology is critical
More important even than years of training, however, is the nature of the education these two types of health professionals get. The core issue is that, while psychologists may be well-equipped behavioral experts, their educational requirements include zero training in medicine.
Stay up to date on fight against scope creep
See how the AMA defends against scope of practice expansions that threaten patient safety.
A science background is crucial for the safe practice of medicine. Case in point: The psychotropic drugs prescribed by psychiatrists are some of the most powerful medications in modern medicine. They can affect a patient’s entire body, and a physician’s training is needed to understand how they can affect multiple organ systems. Meanwhile, patients with mental health disorders also are much likelier to have chronic physical conditions that require medication treatment, so properly understanding the interaction between psychotropic medications and those used to help manage a patient’s comorbidities is vital.
Current post-doctoral psychopharmacology training programs approved by the American Psychological Association require a mere 400 contact hours of didactic instruction. In addition, while such courses—which typically last for a few months—must also offer a clinical practicum with 100 patients seen for psychopharmacology evaluation, no requirement of physician supervision is required.
While state legal training requirements for psychologist prescribing vary widely, advocates consistently push legislation that would allow psychologists to prescribe powerful and potentially addictive medications with as little as a few months of the post-doctoral training noted above.
The AMA has policy opposing the prescribing of medication by psychologists. Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
No more bait and switch
Instead of expanding scope of practice for inadequately trained health professionals, it is time to advance telemedicine and the Collaborative Care Model as key options to help address patients’ behavioral health issues.
The Collaborative Care Model integrates mental and primary health care, extending the reach of psychiatrists by leveraging partnerships with other health professionals. In this care model, psychiatrists, primary care physicians and other behavioral health care clinicians collaborate using shared care plans to deliver care to patients at a familiar location.
The psychiatrist provides guidance and makes diagnostic and treatment recommendations on site or via telemedicine. The Collaborative Care Model is one of the best-studied and most highly effective ways to improve access to mental health care, with over 90 randomized controlled trials demonstrating its effectiveness.
Meanwhile, information collected from the AMA Health Workforce Mapper has demonstrated, in state after state, that nonphysicians—including psychologists—tend to practice in the same areas as physicians such as psychiatrists. Such data shows that expanding the scope of practice for such nonphysicians accomplishes little to improve access to care in rural and other areas underserved by limited access to health care.
Learn more with the AMA about behavioral health integration in physician practices, and explore great resources that set the record straight for policymakers on scope of practice. The AMA is one of the only national organizations that has created hundreds of advocacy tools for medicine to use when fighting scope creep.
