The Prescriptive authority for psychologists (RxP) movement is a public health initiative to give prescriptive authority to psychologists with 2 years of postdoctoral Masters degreed training in clinical psychopharmacology, followed by 1 - 2 years of supervised prescribing, or a Certificate from the Department of Defense program, or the Board Certified Diplomate from the Prescribing Psychologists Register (FICPP or FICPPM), enabling them to prescribe psychotropic medications to treat mental and emotional disorders. Prior to RxP legislation and in states where it has not been passed, this role is played by psychiatrists, who possess a medical degree and thus the authority to prescribe medication, but whose numbers are at a critical shortage, and predominantly by primary care physicians, who can prescribe psychotropics but lack specific training in psychotropic drugs and completely lack training in diagnosing and treating psychological disorders. Prescribing psychologists' training in pharmacology is 2.5x more than that of average physicians and nurse practitioners combined, almost five times more than physicians alone. According to the American Psychological Association, the professional organization representing the interests of psychologists, the movement is a reaction to the growing public need for mental health services, particularly in less urbanized and therefore under-resourced areas where patients have little or no access to psychiatrists.[1]
Currently, in states where RxP legislation has been passed, psychologists who seek prescriptive authority must possess a doctoral level degree (PhD/PsyD/EdD) and a license to practice independently, with five years of clinical experience working with patients as a health care provider, and undergo a post-doctoral Master of Science degree education and training or any of the previous training programs from the Department of Defense or Prescribing Psychologist Register prior to the inception of the postdoctoral Masters. The basic science and medical phase of the post-doctoral Master of Science in Clinical Psychopharmacology degree may be completed with an on-line degree program free of patient interaction, followed by two years of supervised work experience working directly with and prescribing for 100 patients under a physician's or psychiatrist's supervision, making it a total of 4 years of training, the same number of years it takes to go to medical school. The medications they may prescribe are limited to those indicated for mental and emotional health problems; the specific list of approved medications differs by state. The psychologist usually collaborates with a physician on treatment.
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In 1988, the U.S. Department of Defense approved a pilot project to train psychologists in issuing psychotropic medications "under certain circumstances". Guam became the first U.S. territory to approve RxP legislation in 1999. New Mexico became the first state to approve RxP legislation in 2002, and Louisiana followed in 2004. As of April 2007, 5 other states have introduced RxP bills that are under discussion but have yet to be approved. In 2009, psychologists with prescriptive authority in Louisiana had the regulation of their practice of medical psychology and psychology transferred to the Louisiana State Board of Medical Examiners. Louisiana is the only state in the U.S. where a medical board has authority over the regulation of the entire practice of psychology (for medical psychologists). [1][2]
There are several core arguments put forth by RxP advocates, including the following:
Additionally, critics express concern that, if RxP became the norm, the biomedical approach would begin to encroach on the traditional psychology curriculum and clinicians in training would receive less grounding in psychotherapeutic interventions and research.[10]
Legal complaints differ from legal suits, as military personnel cannot sue for redress. [11] Training comparison among three professions prescribing psychotropic medications: psychiatric nurse pratitioners, physicians, and pharmacologically trained psychologists [12]