OPINION – Psychiatrists and Their Guild Seek to Block Access to Mental Health

by Dr. Rick Barnett

“Psychiatrists in Windsor County are like unicorns, they only exist in our imagination!” proclaimed a mental health provider in that region.

The number of psychiatrists is declining across the country, making recruitment of new psychiatrists to Vermont both difficult and expensive. Why then, does the Vermont Psychiatric Association, in partnership with their guild organization, The Vermont Medical Society, want to block access to better and more integrated mental healthcare that costs less than recruiting psychiatrists from out of state.

Telehealth—with the use of telephones and other communications systems—may offer a helpful answer here. Please note that there’s a growing number of prescribing psychologists, with doctoral degrees in psychology and master’s degrees in clinical psychopharmacology, who are authorized to prescribe medications (when deemed helpful) alongside psychotherapy, prescribing in all branches of the military and in five states (New Mexico, Louisiana, Illinois, Idaho, and Iowa.)

Legislation sits in House Health Care and Senate Health and Welfare committees to authorize and bring this workforce here to Vermont. If it’s good enough for our men and women in uniform and our sister states, why would anyone want to block it here in Vermont?

Organized medicine has always fought against other providers entering the health care workforce. The groundbreaking Pew Health Professions Commission, Task Force on HealthCare Workforce Regulation Report (1996), concluded that “[the] ostensible goals of professional regulation to establish standards that protect consumers from incompetent practitioners is eclipsed by the tacit goal of protecting the profession’s economic prerogatives. This dichotomy of goals has created serious shortcomings that include limited public accountability, support for practice monopolies that limit access to care, and lack of national uniformity.”

The Commission further stated “the practical reality is that medicine is the only profession possessing state practice acts that covers all of health care services. With this exclusivity…medicine has no incentive to delete anything. Accordingly, medicine can (and frequently does) see every request for regulatory change from any other profession as a challenge requiring confrontation. Organized medicine has no institutional incentive to compromise…”

Here we are again with the psychiatric establishment with its incredible influence for better or worse, backed by the establishment guild, fighting against progress and the evolution of healthcare. For the past 75 years, organized medicine has reflexively and automatically opposed threats to their monopoly over prescriptive authority, warning of dire consequences to patients. First it was dentists, osteopaths, and podiatrists followed by optometrists, nurse practitioners, naturopaths, and now psychologists.

Psychiatrists and medical associations claim prescribing psychologists have serious deficits inappropriate training for prescriptive authority and thus are a threat to society. That’s a hard argument to keep making, and the same one they’ve used against psychologists for a long time.

From the 1950s through the 1970s, psychiatrists argued that it was not safe to permit psychologists to practice outpatient psychotherapy without medical referral or supervision. Despite the enormous need for better mental health care for the elderly, the American Psychiatric Association desperately, but unsuccessfully, fought to defeat measures to allow the elderly direct access to psychological care under the Medicare program. (OBRA, 1989)

David Satcher, MD, PhD, former United States Surgeon General (1998-2002), stated “If we can demonstrate that psychologists have the training to prescribe, then they should be allowed to prescribe.” There hasn’t been a single incident of harm done by a prescribing psychologist in over 20 years. Psychiatrists know that the extensive education and clinical training across settings and populations meets or exceeds standards of safety, efficacy, and competence. The only thing to do is embrace change rather than fight against it, especially under false claims. The need is there, the workforce is there and growing. Physicians aren’t the gatekeepers of medications. Look at the opioid crisis. Look at prescribing patterns for psychotropics. We need balance and collaboration.

Thankfully, patients and providers on the front lines of healthcare support prescriptive authority for psychologists because they know it leads to better prescribing practices, because there’s less of an emphasis on a “medication-only” approach, and it offers better quality and delivers better outcomes. As esteemed psychiatrist Daniel Carlat, MD, writes in his blog, “the prescribing psychologist is the best thing that can happen to psychiatry.”

Rick Bennett is a clinical psychologist and addiction specialist based in Stowe.

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