THE RING OF FIRE
Pat DeLeon, former APA President
The Illinois Psychological Association’s success in enacting prescriptive authority (RxP) legislation into public law, signed by Governor Pat Quinn on June 25, 2014, is most impressive; especially in the home state of the American Medical Association. It is wonderful for your patients, for the profession, and for the nation. And it only could have happened with the strong, cohesive state association that you are. This landmark legislative success, that empowers psychologists to provide comprehensive, integrative health care for the underserved, reflects the unprecedented changes occurring within our nation’s health care system, epitomized by the enactment of President Obama’s Patient Protection and Affordable Care Act (ACA). As Practice Directorate Executive Director Kathleen Nordal proclaimed during this year’s inspirational APA State Leadership Conference (SLC), where the Illinois Psychological Association was honored: “We need to shake off the negative attitudes some of our colleagues have about what’s happening in health care. This world is changing. And health care is moving ahead – with or without psychology. Too many psychologists are stuck in the traditional 50-minute therapy box. And that box is way too confining. We need to think creatively about where psychology can best influence our evolving health care system… how we practice… where we practice… and what we practice.”
As hard as it is to believe, it had been a decade since Jim Quillin and his colleagues succeeded in Louisiana. During that time, Hawaii and Oregon had bills passed by their legislatures only to be vetoed. Neither state association pursued follow up legislation until this legislative cycle when Hawaii was again successful in having its bill pass the House of Representatives. A January, 2005 fact sheet/memorandum from the Department of Veterans Affairs (VA), regarding optometry’s efforts to expand its scope of practice, serves as a vivid reminder that the opposition to psychology’s prescriptive authority quest is neither about patient care nor about the lack of objective supporting data. Former APA President Ron Fox has made that clear. “As of December 31, 2013 when I was Chair of the APA Insurance Trust, I can attest to the fact that because the Trust policy provides insurance to cover expenses related to licensing board complaints, I know that there have been no complaints or actions taken by state licensing boards regarding prescribing abuses by appropriate trained psychologists.” Jana Martin, CEO of The Trust, reports that there has been only a 15% increase in liability rates ( $75 – $150 annually) for psychologists who are licensed to prescribe.
The VA fact sheet on Laser Eye Procedures Performed by Optometrists noted: “The Veterans Health Administration (VHA) reviewed the 35 cases of laser therapy performed by optometrists, and also reviewed the previous assessments of the care these veterans received. A practicing ophthalmologist was asked to review these cases as well. Of the 35 cases, 32 patients underwent an Yttrium Aluminum Garnet (YAG) posterior capsulotomy for capsular opacification following cataract removal. The remaining three had bilateral peripheral iridotomies for angle crowding. The overall outcomes of these patients were acceptable and there were no significant complications. Based on this review and analysis of previous assessments, VHA concludes that the outcomes of these patients were acceptable.” Not surprisingly, organized medicine nevertheless opined to the Congress that optometrists performing this clinical procedure represented a “public health hazard” and were subjecting veterans to less than optimal care.
In many ways, the ongoing battles between optometry and their medical counterparts parallels what psychology faces, as do the disagreements between advanced practice nursing and medicine. The Department of Defense (DoD) Walter Reed/Uniformed Services University of the Health Sciences psychopharmacology training program (frequently referred to as the PDP) began in the summer of 1991, and was closely monitored by the American College of
Neuropsychopharmacology (ACNP). ACNP’s conclusion: “All 10 graduates of the PDP filled critical needs, and they performed with excellence wherever they were placed.” On June 17, 1994, Navy Commander John Sexton and Lt. Commander Morgan Sammons became the first graduates and as Ron Fox has noted, DoD prescribing psychologists provide excellent care. And yet, why haven’t the VA and our private health care systems enthusiastically embraced this potential for psychology providing quality care? We would suggest the missing element has been psychology’s hesitation in accepting this important clinical responsibility. Very few of our colleagues appreciate their societal responsibility to be visionary leaders in addressing society’s real needs, as Beth Rom-Rymer and your other colleagues in Illinois have.
Former USAF Prescribing Psychologist Elaine Foster recently shared her concerns with her own elected official: “After graduating from the DoD Psychopharmacology Demonstration Project (PDP) I served as a prescribing psychologist in the Air Force for over 20 years. I continued to serve our active duty military after retiring, again as a prescribing psychologist under contract with the Air Force. During that time, I prescribed for our veterans when we had space available at our military clinic…. If I walked across the hospital parking lot to our annexed VA clinic, I could no longer prescribe to that same patient I’d been prescribing to while he or she was active duty. The current VA restrictions are illogical…. Because New Mexico recognizes prescribing psychologists, I can now prescribe to our veterans, but only in New Mexico, and only through a third party contractor…. This just does not make sense and is a clear waste of federal funds.”
Bob McGrath, Director of the clinical psychopharmacology training program at Fairleigh Dickinson University, estimates that today there are more than 1,750 psychologists who have completed their post-doctoral psychopharmacology training. When the APA Council of Representatives endorsed RxP as association policy in 1995, that standard was reasonably adopted in order to address the sincere concerns of those who were afraid that psychology might lose its fundamental identity. However, as Katherine points out, times have changed and it is now appropriate that you, Illinois psychologists, are facilitating psychopharmacology training at the graduate level, as well as facilitating training in the basic sciences at the undergraduate level, throughout your state. Those students who are passionate about the study of psychology and are strong in the hard sciences will be well prepared for a career as a prescribing psychologist. The Illinois Psychological Association has demonstrated to all of us that psychology can be in control of its own destiny and is willing to change with the times. My sincerest appreciation for your vision, persistence, and responsiveness to your patients’ real needs. And, it burns, burns, burns.
Pat DeLeon, former APA President – Illinois Psychological Association – June, 2015