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A turf war over mental health

Psychologists seek power to prescribe

BALTIMORE -- Across the United States, psychiatrists and psychologists are engaged in a bruising battle. Two professions normally focused on respecting emotions and listening are instead hurling barbs, accusing each other of caring more about money and turf than patients.

The issue: giving psychologists the authority to prescribe drugs.

A long-smoldering debate ignited last month when Louisiana passed a law allowing psychologists there to write prescriptions. Psychiatrists, who as medical doctors can prescribe, bitterly fought the legislation and said they fear it will generate momentum in other states.

Dr. Michelle Riba, president of the American Psychiatric Association, calls the Louisiana law ''really scary," saying undertrained nonphysicians will harm, and perhaps kill, patients. ''Without a doubt, they'll make mistakes," she said.

Psychologists say the ability to prescribe will help them better treat their patients. ''It's just good medical sense," said Jim Quillin, a psychologist who helped lead the fight in Louisiana.

Two years ago, New Mexico also passed such legislation. But bureaucratic disputes between the state's psychological and medical boards have kept the law from taking effect, so Louisiana psychologists will probably be the first to prescribe medicine, possibly by this summer.

This year, seven other states considered, but did not pass, ''RxP" bills, as the measures are known.

Louisiana psychologists would have to pass a 400-hour psychopharmacology program to prescribe.

Psychologists argue that granting prescription privileges will alleviate shortages of psychiatrists. In some rural states, including Louisiana, patients who might need medication wait months to see a psychiatrist.

''When a patient needs to see a psychiatrist, it's usually a fairly immediate need," said Quillin, who has a private practice in Alexandria, La..

But critics say medical psychologist programs are a drop in the bucket compared with the training doctors must undergo. Dr. Steven S. Sharfstein, president of the Towson, Md.-based Sheppard Pratt Health System, said the psychologists' 400-hour curriculum would cover only five weeks of the typical 80-hours-a-week medical school residency.

Psychiatrists also say that many of these programs depend heavily on distance learning, in which students learn by computer and meet through chat rooms.

Proponents say the Louisiana law includes an effective safeguard against error: Before prescribing a drug, the psychologists must consult with a physician, who can veto the prescription if it seems unnecessary or incorrect.

That's not enough, said Sharfstein, who contends that psychologists who want to prescribe ''should go to medical school."

But many psychologists say they are at least as capable as primary-care physicians, who now prescribe at least two-thirds of all drugs for mental illness.

Many psychiatrists accuse psychologists of pursuing the right to prescribe for financial reasons. Because more social workers and licensed professional counselors now offer psychotherapy, psychologists are eager to make themselves more appealing to patients, they say.

''This is mostly a financial issue," said Dr. Patrick O'Neill, head of the Louisiana psychiatrists' group.

Russ Newman, of the American Psychological Association, acknowledges that appealing to consumers plays a role, but says psychiatrists are the ones motivated by economics. ''They're trying to protect their market," he said.

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