"RxP refers to "Prescriptive authority for Psychologists." It is a public health initiative to achieve legislated authority for properly educated, trained and licensed clinical psychologists to prescribe psychotropic medications to individuals requiring such treatment. prescriptive authority to medical 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. 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 medical psychologist usually collaborates with a physician on treatment.

History

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.^[1][2]

Supporting arguments

There are several core arguments put forth by RxP advocates, including the following:

• Other non-physicians have prescription privileges, such as optometrists, nurse practitioners, physician's assistants, and pharmacists, all of which with the exception of pharmacists, receive less training in clinical pharmacology, therapeutics, and psychopharmacology.^[3]
• The training model is supported by a complete lack of legal complaint after eight years regarding the practice of the initial ten psychologists trained by the U.S. Department of Defense.^[3] Legal complaints differ from legal suits, as military personnel cannot sue for redress. ^[4]
• Access to medication would be immediate as opposed to long waiting times that are sometimes necessary to see a qualified psychiatrist.^[5]
• It would not come at the expense of adequate training in the science of psychology, assessment, or psychotherapy because such education would be post-doctoral and more extensive than the average physician, and twice as much pharmacology training than nurse practitioners and physician assistants receive who still cannot diagnose psychiatric disorders.^[5]
• It would address the fact that many lack access to psychiatrists (especially in rural areas).^[6][7]
• It would make a more distinct separation between doctoral and masters-level practitioners,^[6] and between doctoral and post-doctoral level practitioners.^[8]
• It would allow the psychologist control of the entire treatment process, which would avoid the complications of interprofessional collaboration while also saving clients money.^[6]
• Adding competence to consult with general practitioners who need professional advice regarding psychotropic medications when a proper psychiatrist is unavailable.^[9]
• Psychopharmaceutical training allows for better client advocacy.^[9]

Opposition

• Prescriptive authority, when sought by other non-physicians such as nurses, was also controversial to physicians and within their professions even though their training was already medical in nature. The medical community has always fought granting prescriptive authority to other types of degreed trained professionals and eventually lost (NPs, PAs, podiatrists, etc).
• Many of the allied health professions Ex. Pharmacists do not teach basic principles of internal medicine, they key in successful diagnosis, which is one of the reasons prescription writing is argued.

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]

References

Legal complaints differ from legal suits, as military personnel cannot sue for redress. ^[11]