When it comes to addressing mental health inequities and lack of access to high-quality psychiatric care in the U.S., allowing psychologists to prescribe medicine brings with it a host of potential harms.
Discussing a move in the Virginia statehouse to examine whether to hand prescriptive power to psychologists there, experts such as AMA member VijayaLakshmi Appareddy, MD, explain some of the potential dangers in states where the practice is allowed.
Psychologists are well-trained “for psychotherapy, educational testing [and] psychological testing, and they're extremely good at what they do,” said Dr. Appareddy, a Chattanooga, Tennessee-based psychiatrist and the vice chair of the AMA Council on Legislation. “But they do not have the medical background, and they are not trained to work in medicine. They are not allowed to practice in other medical specialties, so why should they be psychiatrists?”
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care.
And physicians agree: Though mental health treatment is critical and the need for it is increasing, the way forward is not to give psychologists another role for which they are not trained, but to improve access to quality mental health care for all.
Right now, Colorado, Idaho, Illinois, Iowa, Louisiana, New Mexico and Utah allow some psychologists to prescribe medicine. Meanwhile, a study published in Clinical Psychology: Science and Practice found that, as of last year, only 226 psychologists were prescribing medicine in the U.S. In 2025, legislative efforts failed in nine states to expand prescriptive authority to psychologists in at least some cases.
Little to no pharmacology training
Psychologists, who typically earn PsyD or PhD doctorate-level degrees, usually get a bachelor’s degree, four to six years of graduate-level education and do a one-year internship. Often, there are no undergraduate prerequisites in physiology, anatomy or chemistry, which there are for medical school students.
By contrast, psychiatrists earn a bachelor’s degree, then complete four years of medical school—earning degrees as medical doctors, MDs, or doctors of osteopathic medicine, DOs—followed by four to six additional years of post-graduate training via medical residency and, sometimes, fellowship.
Psychologists complete a one-year internship while psychiatrists get between 12,000 and 16,000 hours of patient care during their four- to six-year residency program. And they receive training in different types of patient care, with psychiatrists learning how to provide medical care in addition to the behavioral and mental health care that psychologists are taught to provide.
Furthermore, the model psychopharmacology educational program endorsed by the American Psychological Association as a prerequisite for prescriptive authority only requires the didactic curriculum contain 400 contact hours. Experts know that the training is inadequate to prepare psychologists for prescribing medication.
Medical care “looks very different when you read about it in a book and then you see how it [treatment] affects a person and what that looks like,” said Rebecca Weintraub Brendel, MD, JD, associate professor of psychiatry at Harvard Medical School and chair of the AMA Council on Ethical and Judicial Affairs.
Medical conditions can be overlooked
Dr. Brendel said the stakes are high when psychologists evaluate patients who may be suffering from medical conditions that are masked by, or appear to be the result of, psychiatric conditions.
“I’ve seen many examples in my practice over the past 20-plus years in which a patient would come in as a referral for a seemingly relatively straightforward, even mild to moderate, mental health condition that actually turned out to be a critical medical illness,” she said.
Psychiatrists might encounter a “patient who comes in short of breath, feeling anxious. They're referred for treatment of anxiety, and you get an EKG [electrocardiogram], and you realize that the patient is anxious and short of breath because they have air hunger,” Dr. Brendel said. “They have a pulmonary embolus or they have an irregular heart rhythm like atrial fibrillation, both conditions that require immediate medical attention.”
The argument that psychologists can simply refer patients for testing elsewhere fails to consider that psychiatrists are trained in properly assessing and identifying when doing so is necessary.
“Some people would argue that you could do a test—you could send the patient for an MRI or you could send the patient for a medical evaluation. But, in fact, that doesn't necessarily happen unless you know what to look for,” Dr. Brendel said.
“It really doesn't happen unless you have that experience and that clinical judgment that comes with having seen thousands of patients over many years to discern which patient is really sick and needs medical attention and which patient is fitting into a spectrum of a primary psychiatric diagnosis,” she added.
Physician training a must for safe Rx
The medical training that psychiatrists get uniquely positions them to evaluate a patient, then determine when an issue is medical in nature and when it is psychiatric.
“Being attuned to the entire realm of diagnostic possibility and then narrowing it down based on knowledge, experience and skill is really what distinguishes a psychiatrist from any other kind of mental health professional,” said Dr. Brendel, who also is past president of the American Psychiatric Association.
Dr. Appareddy added that many psychiatrists further specialize their area of practice because of how complex treatment can be for different populations. Many of the proposed and enacted laws that extend prescriptive authority to psychologists do not make exceptions for children, pregnant patients, older adults or those patients considered medically complex.
“The medications are completely different. The reactions are completely different. The medical problems are completely different” in adults and children, and in those with intellectual disabilities and medically complex patients. She said there are “so many examples of how all these subpopulations or subspecialties need much more complex” training.
The tremendous amount there is to know, she said, creates specialized knowledge that is impossible to learn in the limited training that psychologists get.
Job doesn’t end when prescribing starts
Even if and when a physician determines that psychotropic medication is indicated for the management of a patient’s condition, the need for medical expertise doesn’t end. Dr. Appareddy noted that psychiatrists don’t just do comprehensive evaluations, examinations and laboratory tests before prescribing but also as patients stabilize on a medication and as follow-ups.
“Mental health disorders or diagnoses or symptoms are very similar to any other medical diagnosis we have, which can change over a period of time,” Dr. Appareddy said. “The medications may stop working, they [patients] may have side effects, they may have a new diagnosis or new symptoms. ... When somebody has diabetes, hypertension, it just doesn't stay that way, it needs to be constantly monitored.”
Dr. Brendel pointed out that “psychiatric medications can affect every single organ system in the body,” and a psychiatrist must be familiar with rashes that medication can cause, as well as side effects in breathing, circulation and thyroid or endocrine function. Physicians also need to monitor for diabetes or metabolic syndromes.
“Anytime you introduce a medication or any intervention to a patient, you've now created a situation in which you need to monitor and to assess what the effect of that intervention is,” Dr. Brendel said. “Without a broad base of medical knowledge to understand the interactions between drugs themselves, between a drug and an otherwise-healthy individual—other than a particular organ system problem—you simply do not have the knowledge to safely prescribe.”
Shortages are real—so are these fixes
There is a shortage of psychiatrists—and physicians of all stripes—in the U.S., but there is also a shortage of psychologists and other behavioral health professionals. Efforts to improperly extend prescriptive power to psychologists have not improved access.
Meanwhile, information collected from the AMA Health Workforce Mapper has demonstrated that nonphysicians—including psychologists—tend to practice in the same areas as physicians, including psychiatrists. The data shows that expanding nonphysicians’ scope of practice is unlikely to improve care access in rural and other underserved areas.
In Virginia, lawmakers voted to study the possibility of letting psychologists prescribe medicine in the state. A work group on the topic has been directed to report its findings to state House and Senate committees by Nov. 1. The AMA recently submitted comments (PDF) to the state’s medical and psychology boards calling any expansion of prescriptive power “well-intentioned” but “neither a safe nor effective option.”
“We understand that there is an ongoing and very necessary dialogue around improving access to mental health care in Virginia, and we encourage these conversations to continue,” wrote AMA CEO and Executive Vice President John J. Whyte, MD, MPH. “However, we strongly believe, and the data show, that granting prescriptive authority to psychologists is a high cost, low-impact response to the mental health crisis.”
The AMA has policy opposing the prescribing of medication by psychologists. Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
There are effective solutions to address the very real need to improve patients’ access to high-quality mental health care. These include collaborative care models, permitting and paying for telemental health on a permanent basis, improving parity in insurance coverage, and creating more residency slots overall.
The Centers for Medicare & Medicaid Services announced last year that of the 200 new residency slots in 2025, 70% would be in primary care and psychiatry programs.
“Giving people access to unsafe care is not giving people access to care,” Dr. Brendel said. “It doesn't solve a problem; it just perpetuates the problem. And it perpetuates the problem for persons living with mental illness, who already are stigmatized and excluded from benefits that others have for almost every other kind of illness.”
Learn more with the AMA about behavioral health integration in physician practices, and explore great resources that set the record straight for policymakers on scope of practice. The AMA is one of the only national organizations that has created hundreds of advocacy tools for medicine to use when fighting scope creep.
