Writing a Prescription for Controversy

By Jeffrey Kluger

Psychologists and psychiatrists may seem like two sides of the same medical coin, but there has always been one thing that separates them: the power of the prescription pad. Last week New Mexico Governor Gary Johnson leveled the field, signing a bill that makes his state the first to offer Ph.D. psychologists the same prescribing rights as M.D. psychiatrists. The move has sparked renewed debate about just who is qualified to prescribe to whom. Says Dr. Neil Arnet, an Albuquerque psychiatrist: "They got through legislation what they needed to have gotten through training and education."

Whatever the psychiatrists think, the psychologists believe the change was long overdue. The hands-on work they do with patients more than qualifies them to determine prescription strategies, they argue, particularly if they get the necessary training--and the new law provides for that. New Mexico psychologists will have to undergo 450 hours of course work, pass an exam and still clear all prescriptions with a psychiatrist for two years before they will be free to prescribe on their own.

When that happens, they could mend a big rip in the mental-health safety net. In New Mexico's rural areas, there are far fewer practicing psychiatrists than psychologists. That means patients sometimes must wait as long as five months to see someone licensed to prescribe. "Psychologists use a range of tools to help clients," says Elaine LeVine, a Las Cruces psychologist who chaired the local push to get the legislation passed. "Medication will be an adjunct."

As New Mexico goes, so may go others. Although 14 states have defeated similar legislation, four more--Georgia, Illinois, Hawaii and Tennessee--have bills pending. And how will managed care respond to all the potential new prescribers? "We are not yet in a position to make a statement," says a spokeswoman for New Mexico's Presbyterian Health Services. Insurers across the country may have to get themselves in position soon.

--By Jeffrey Kluger