Efficient or Dangerous?
Governor Jared Polis signed House Bill 1071 Friday which allows Colorado psychologists to prescribe mental health or psych meds. This bill passed into law despite objection from psychiatrists, who are medical doctors.
Psychiatry training includes a college degree, four years of medical school, then an additional four years of psychiatry residency training. Some psychiatrists complete an additional 1-2 years of fellowship training in such fields as child and adolescent psychiatry, addiction, forensic, or geriatric psychiatry.
Clinical psychologists, after their college degree, obtain either a masters or doctoral degree, taking an additional 2-5 years.
Post college training for a psychiatrist is at least 8 years, for a clinical psychologist, from 2-5 years. Is this difference important or relevant?
These “turf battles” are common in the healthcare world. Examples include ophthalmology versus optometry, internists versus nurse practitioners, midwives versus obstetricians, or anesthesiologists versus nurse anesthetists. For most routine care, the differences may not be significant, but medicine isn’t always routine.
Flying a plane is typically routine for a junior pilot but when weather, engine failure, or myriad other mishaps occur, experience can be the difference between life and death. Ask the passengers on Captain Sully Sullenberger’s flight which landed safely in the Hudson River.
But this new Colorado law is not just the right to prescribe psych meds. There are a few hoops for psychologists to first jump through. As the Colorado Sun noted,
The law creates a path for psychologists to write mental health prescriptions, requiring that they receive a postdoctoral master’s degree in clinical psychopharmacology. They also would have to pass a national board exam and go through a year of preceptorship under a licensed prescriber. For the following two years, they would have a conditional prescription certificate allowing them to prescribe medications only under the supervision of a consulting physician.
So, an additional master’s degree, standardized exam, preceptorship, and supervision, totaling 5 years would be required before a psychologist could prescribe prescription psychiatric meds.
There are not enough practicing psychiatrists currently. Insurance reimbursement is inadequate, and many psychiatrists do not accept insurance, preferring cash or credit card, to cover the costs of practice and earning a living commensurate with 8-10 years of training post college.
Many patients wait months for an appointment with a psychiatrist, and if in crisis, the emergency room or self-care won’t cut it. More than half of US counties lack a single psychiatrist.
America faces a mental health crisis, and increasing the supply of practitioners to care for the numerous patients in need may be a good thing. Five states already allow this including New Mexico which instituted a similar law 20 years ago.
As Colorado is on the vanguard of other mental health issues including legalized marijuana and mushrooms, it makes sense that we would be leading the charge on providing more mental healthcare for those that previous laws might have pushed toward needing such care.
Time will tell how this experiment plays out. Hopefully for the good.