Bill Would Let Psychologists Prescribe Medicine

DES MOINES, Iowa — A bill pending in the Iowa House would allow specially trained psychologists to prescribe medication to mentally ill people in hopes of alleviating a shortage of treatment options, but the proposal has run into opposition from some of the state’s psychiatrists.

Sen. Joe Bolkcom, a Democrat from Iowa City, has been the leading supporter of the bill, which would allow licensed psychologists who complete additional coursework and training to prescribe about 100 medications. Supporters of the bill hope to ease treatment delays, especially among rural patients, that can stretch on for a month or longer and require long drives to larger cities.

“We have a shortage of mental health professionals in Iowa,” Bolkcom said. “I think that we need more access to these medications that we know are effective.”

The bill passed the Senate earlier this month but hasn’t come up for a vote in the House as lawmakers work to approve budget bills and adjourn the legislative session.

The legislation is meant to address a chronic shortage of psychiatrists and others who can prescribe medications for people seeking treatment for mental illnesses. A 2015 report estimated there are about 120,000 people in Iowa with serious mental illness, but only about 300 psychiatrists, nurse practitioners, and physician assistants who can prescribe medication.
Iowa is ranked 47th nationally in the number of practicing psychiatrists per capita.

“The shortage of psychiatry in the state is really bad… especially if you look out into rural areas, there’s almost nobody,” said Matthew Dzak, a psychologist in Centerville.

Kristina Richey, the director of Integrated Health Home, which helps people get treatment in southwest Iowa, said letting psychologists prescribe drugs would help rural clients.

“It’s a challenge just to get therapist to come to southwest Iowa,” she said. “By adding another person that can prescribe medication is just a win all around for us.”

Before being allowed to prescribe medication, psychologists would need to complete a post-doctoral master’s degree in clinical psychopharmacology, undergo a supervised practicum with a licensed doctor, pass a national exam and then spend an additional two years under the supervision of a doctor.

There’s little question that Iowa isn’t meeting the needs of its mentally ill residents, but Jerry Greenfield, the president-elect of the Iowa Psychiatric Society, said it would be risky for someone without medical training to prescribe medication. Psychiatrists must complete over 12 years of education and training, including medical school and a residency program. The Iowa Psychiatric Society has opposed the legislation.

“The bottom line is psychiatric medications can save lives but they can kill people, too,” said Greenfield, a psychiatrist who works at the Iowa Correctional Institution for Women in Mitchellville.

Greenfield said medication commonly used to treat mental illness can affect the kidney, liver, heart and neurological system.

The Senate-approved bill also states that the Board of Psychology would set rules related to prescribing psychologists. The board would need to create a subcommittee that includes a physician to develop rules for practice.

But Joyce Vista-Wayne, a child and adolescent psychiatrist in Des Moines, said the Board of Psychology has no experience in overseeing prescriptive authority and she questioned why the Board of Medicine wouldn’t have that power.

“Without adequate training and oversight the bill really presents a danger to patient safety across the state,” she said.
Iowa’s law would be similar to laws approved in New Mexico, Louisiana and Illinois.

Eric Torres the executive director of the Louisiana State Board of Medical Examiners said there are now about 90 psychologists who are licensed to prescribe medications in the state, and there have been no major issues with the new role. Christina Vento, a prescribing psychologist in New Mexico, said her state has a little less than 60 psychologists with the added authority. She said she wasn’t aware of any prescribing psychologists in Illinois, where the law is fairly new and the training is more extensive.

Greenfield said possible alternatives to the psychology proposal could include expanding tele-psychiatry, which connects doctors and patients electronically, and providing more training programs.

The University of Iowa now has Iowa’s only psychiatric residency training program, and the program’s director Donald Black said there are 28 residents in the general adult psychiatry program with about two dozen additional residents in specialized programs.

He said roughly 70 percent of residents choose to stay in Iowa following graduation, but that number drops to about 40 percent after 10 years.

Getting providers to locate in rural Iowa has proved especially difficult.

“We don’t have a lot of people knocking on the door saying, ‘Hey we’re looking for a place to practice,’“ said John Bigelow, a psychologist in Atlantic. “There’s just not a lot of people that want to settle here.”

Bigelow noted, however, that it’s not only a rural problem. Although there are more doctors in urban areas, he said the competition to get an appointment is higher and waits also can be long.

Elizabeth Lonning, a psychologist in Davenport, has already received the post-doctorate degree needed under the bill’s training requirements. She said the state desperately needs more mid-level prescribers to enhance accessibility.
“We’re really behind” she said.

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