Wednesday, April 7, 2010
Governor Kulongoski has a Decision to Make
Governor Ted Kulongoski of Oregon finds himself in the unenviable position of deciding the fate of two professions. And he has to do it either today or tomorrow.
Yes, I hyperbolize...a little. Senate Bill 1046 would not actually hand psychologists prescription pads. Instead, the bill would allow the Oregon Medical Board to issue prescriptive privileges to psychologists who are properly trained. Before any privileges are handed out, however, a task force of psychiatrists and psychologists would have to hammer out final guidelines, including exactly how much training is required, what kind of collaboration with physicians is needed, and which medications psychologists would be allowed to prescribe.
The Governor has put this bill on a list of measures that he is "threatening" to veto. Apparently, this is his invitation to all the stakeholders to whip themselves up into even more of a frenzy in their efforts to lobby him. My wild guess is that Kulongoski was initially in favor of the bill, but as crunch time arrived and he got more and more of an earful from Oregon physicians worried about loss of income, he began to reconsider. These last few days will serve as a quick straw poll to find out how much political damage he might do to himself if he were to sign the bill.
Personally, I support the bill because I believe it requires enough medical training to produce safe prescribers. At least two Oregon psychiatrists support the overall concept of psychologists prescribing, including Jim Phelps, who wrote this editorial in favor of the bill in Psychiatric Times, and Joseph Arpaia, who has commented on this blog. Both Dr. Phelps and Dr. Arpaia are joining with me in forming a multi-disciplinary study group to develop a list of principles for appropriate training of psychologists interested in prescribing. If anybody else wants to join, please e-mail me directly at firstname.lastname@example.org. I suspect there are many more open minded psychiatrists out there who are afraid of "coming out" on this issue because they fear the wrath of colleagues.
Although I have been asked to actively lobby for this bill, I've declined, for various reasons, not the least of which is financial. I get most of my income from psychiatrists subscribing to my newsletters. The more political I become on this issue, the more I fear subscription cancellations.
But more nobly, I think there is a far more important underlying issue than this particular bill. There is a critical shortage of psychiatric prescribers in the U.S. The most recent estimates by the University of North Carolina Scheps Center, published in a series of article in Psychiatric Services, documented a shortage of prescribers in 96% of U.S. counties, and estimated that only 50% of the needs of psychiatric patients are currently being met. We must offer more realistic solutions than telepsychiatry, increasing residency slots (which we can barely fill with qualified applicants as it is), and phone call consultation with primary care doctors.
Rather than lobbying for specific bills, I want to get psychiatrists and psychologists together to jointly come up with a position paper on best practices for training, supervising, and monitoring prescribing psychologists. This could then serve as a blueprint for prescription legislation in other states (and in Oregon, which will surely pass another version of this bill next year if the current one is vetoed.)