Editor’s Note: In an article in the January/February edition of The National Psychologist, some psychologists in Louisiana expressed concern that a change transferring oversight of “medical psychologists” to the state medical board threatens the autonomy of non-prescribing psychologists. The following is a response from a leader of the MP movement.
In 2009, Louisiana’s legislature overwhelmingly passed the “Medical Psychology Practices Act,” establishing in statute a new practice of psychology which combines the clinical practice of psychology with medical practices, defining medical psychology as “…that profession of the health sciences which deals with the examination, diagnosis, psychological, pharmacologic and other somatic treatment and/or management of mental, nervous, emotional, behavioral, substance abuse or cognitive disorders, and specifically includes the authority to administer, distribute without charge and/or prescribe drugs….”
The regulatory authority over the practice of medical psychology, under this act, was transferred from the Louisiana State Board of Examiners of Psychologists (LSBEP) to the Louisiana State Board of Medical Examiners (LSBME) in recognition of the implicit medical component of the practice of medical psychology.
The Medical Psychology Practices Act establishes two levels of practice: an entry level of medical psychologist (MP) requiring ongoing consultation and collaboration with a primary or referring physician, and an “Advanced Practice” level. Those MPs holding advanced practice certificates are authorized to practice without prior or direct ongoing consultation by copying examination findings and clinic notes to the patient’s physician, a practicing allowing for and facilitating enhanced integrative care.
In order to qualify for the advanced practice certification, an applicant must practice as a medical psychologist for a minimum of three years, document a minimum of 100 cases involving the prescription of certain classes of psychopharmacologic agents, receive the recommendation of two physicians familiar with the competence of the MP and document an additional 100 hours of continuing medical education in the medical psychological management of patients.
MPs must also be eligible for a Controlled and Dangerous Substances permit issued by the state (currently issued by the Louisiana State Board of Pharmacy to all practitioners authorized to prescribe medication in Louisiana) and registration by the United States Drug Enforcement Authority.
Psychologists desiring to become medical psychologists after January 2010 must hold an unrestricted license to practice psychology as issued by the LSBEP, have successfully graduated with a post-doctoral masters degree in psychopharmacology from a regionally accredited institution or an equivalent level of training approved by the medical board and pass a national exam in psychopharmacology approved by the board.
Once licensed as a medical psychologist, the MP may retain his or her licensure with LSBEP but is not required to do so, as the authority to continue the non-medical practice of psychology is explicitly authorized in statute for those licensed as MPs. As of this writing, over 50 MPs are licensed to practice in Louisiana, with seven also holding certificates of advanced practice.
Medical psychologists are required to continue their professional education in two ways: MPs must undertake a minimum of 15 hours of CE a year in psychology as provided by the Louisiana Psychological Association (LPA), the American Psychological Association (APA) or other sponsors approved by the board. An additional 20 hours of CME approved by the Accreditation Council for Continuing Medical Education, the Louisiana Academy of Medical Psychologists (LAMP), the Louisiana State Medical Society and other sponsors approved by the board must be completed each year in order to renew MP licenses.
MPs must adhere to ethical standards promulgated by the APA and the American Medical Association.
Critics of the statute fear that it represents a Trojan horse by which medicine will seek to “control” psychology. The basis of this concern is unclear but may reflect the common anxieties that often attend change.
In truth, medicine is understandably interested in regulating the practice of medicine, and medical psychologists in Louisiana have come to acknowledge that medical psychology includes medical acts. Organized medicine has no particular interest in the regulation of psychotherapeutic/behavioral interventions or in psychological assessment.
In fact, LSBME and LSBEP have developed a collegial working relationship since the passage of this act, a relationship that previously did not exist. Others have expressed concern over psychology’s “medicalization.” Historically, similar concerns have surfaced each time the character of the practice of psychology has undergone a dramatic shift (e.g., practice of psychotherapy, licensure as a healthcare profession, inclusion in health insurance).
The integration of medical procedures into the practice of psychology instead represents a natural evolution of our profession, and fears that doing so will “corrupt our values” may be best viewed as akin to the kind of primitive religious fears sometimes exhibited when faced with the prospects of interfaith marriages.
Psychology is an evolving science and profession, not a static belief system characterized by unyielding orthodoxy. It is the position of LAMP that optimized public policy demands that health care professions abandon long held turf positions and work collaboratively to design a system of rational healthcare which best serves the public good.
In concert with our colleagues in medicine, we believe that we have contributed to doing so.
James W. Quillin, Ph.D., MP, is a prescribing psychologist in Alexandria, La., who has long been active in the LPA and the APA. He is a founding member of LAMP and was among leaders instrumental in gaining passage of RxP authority for properly trained psychologists in Louisiana in 2004.
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