Prescribing rights dominate scope-of-practice bills

The debate over passage pits psychiatrists against allied professionals.

By Myrle Croasdale, AMNews staff. April 14, 2003.

Flush from last year's victory in the New Mexico Legislature, psychologists have targeted 12 states for prescriptive authority battles this year.

Legislation to allow these nonphysicians to write prescriptions has been introduced in nine states -- Florida, Georgia, Hawaii, Illinois, New Hampshire, Oregon, Tennessee, Texas and Wyoming -- according to the National Conference of State Legislatures.

Psychiatrists have defeated bills in Hawaii and Wyoming, with New Hampshire likely to vote it down as well. Three other states, Connecticut, Louisiana and Oklahoma, could soon find themselves caught in the crossfire over scope-of-practice concerns.

The debate in this most recent scope-of-practice arena mirrors those of battles gone by: Physicians talk about quality and patient safety and emphasize that a medical degree should be required to practice medicine. Allied practitioners, however, argue that expanding their practices allows more patients access to care. It's an argument that worked particularly well for psychologists in New Mexico, where 29 of 33 counties are considered medically underserved by the federal government.

While the legislation was not defeated in New Mexico, physicians say they are not ready to concede.

"The fact that a bill passed in New Mexico makes us very concerned about other states," said Jeremy Lazarus, MD, chair of the American Psychiatric Assn. Council on Advocacy and Public Policy.

Physicians say it may seem relatively simple to prescribe the newer antidepressants, which have fewer negative side effects than their predecessors, but many people seeking relief from depression have other health conditions, and psychotropic medications affect all organs of the body, not just the brain.