Spring 2019: Volume 75, Number 1
By: David Shearer, Ph.D. Clinical and Prescribing Psychologist
In the later part of 2017 I approached WSPA with my interest in pursuing legislation in Washington State that would permit appropriately trained psychologists to prescribe psychotropic medication (often referred to as RxP). At that time I had been practicing as a prescribing psychologist in a federal facility for about eight years in Washington. Unbeknownst to me there had been a previous effort to pursue RxP in the State around 2007 that met with equivocal support from the WSPA membership. Understandably, especially in light of this prior history, the WSPA Board was not prepared to endorse RxP without more information. However, they were willing to sponsor an RxP Workgroup to begin exploring the pros and cons of pursuing RxP in Washington. This culminated in late 2018 in the development of a survey sent to over 2500 psychologists licensed in Washington State (both WSPA members and non-members). The purpose of the survey was to help inform the WSPA Board of the level of support, or lack thereof, for RxP. The purpose of the current article is to summarize the results of this survey.
In all, 223 psychologists responded to the survey which, to improve the odds of being seen and opened, was sent at least twice. Approximately 50% of the about 2500 psychologists who received the survey opened the email implying awareness of the topic. Hopefully, those who felt most strongly one way or another took the time to fill out the survey. Twenty six percent of WSPA member surveyed responded for a total of 127 respondents. Five percent of non-WSPA members surveyed responded for a total of 96 respondents. Most respondents also provided comments clarifying their views.
The two primary questions on the survey were Q1) Do you support pursuing RxP in Washington? (responses were rated on a 5 point Likert scale with 1 = No Support, 3 = Neutral Support, and 5 = Fully Support) and Q4) If RxP was passed in the State how interested would you be in getting trained to prescribe (again, responses were rated on a 5-point Likert scale with 1 = Not Interested, 3 = Maybe Interested, and 5 = Definitely Interested). See Table 1 and Table 2, respectively. In the table for question #1 the Likert responses of 4 and 5 (Support to Fully Support) and the responses of 1 and 2 (No Support to Unlikely Support) were combined to facilitate interpretation of results. Similarly, for question #4 the Likert responses of 4 and 5 (Interested to Definitely Interested) and the responses of 1 and 2 (No to Low Interest) were combined.
Question #1: Would you support the pursuit of expanding the practice of properly trained psychologists in Washington State to include the prescription of psychotropic medications?
As can be seen, the respondents overwhelmingly supported pursuit of RxP in the State with a combined support of 86.5%, a non-WSPA member support of 95%, and a WSPA member support of 80%. Less than 10% of respondents were not in support as evident in the combined and WSPA member response; only 3% of non-WSPA members failed to support RxP.
Question #4: If legislation passed in the State to permit psychologists to prescribe would you be interested in pursuing training to obtain these privileges?
Approximately half of all survey respondents expressed interest in pursuing training in RxP if legislation was passed in the State. Interest in pursuing RxP training was higher in the non-WSPA respondents at 75% as compared to WSPA members at 36%. If these numbers can be extrapolated to reflect all licensed psychologist in the State it suggests that upward of 1200 psychologists would be interested in pursuing RxP training.
Would you support the pursuit of expanding the practice of properly trained psychologists in Washington State to include the prescription of psychotropic medications?
|LEVEL OF |
DoH + WSPA
|Dept. of Health |
|N = 223||N = 96||N = 127|
|Support to Fully Support||86.5%||95%||80%|
|No to Low Support||7%||3%||9.5%|
If legislation passed in the State to permit psychologists to prescribe would you be interested in pursuing training to obtain these privileges?
|LEVEL OF INTEREST||TOTAL |
DoH + WSPA
|Dept. of Health |
|N = 223||N = 96||N = 127|
|Interested to Definitely Interested||53%||75%||36%|
|Low to Not Interested||33%||17%||45%|
Many respondents provided commentary on their responses and a qualitative approach was taken to categorizing both positive and negative responses. For those supporting the pursuit of RxP the most common reasons, in order of frequency, were 1) improvement in overall access to psychopharmacological prescribers, 2) appropriately trained psychologists are uniquely positioned to provide competent, safe and high quality psychotropic prescribing by virtue of their training, biopsychosocial perspective and skill in differential diagnosis, 3) RxP would improve access to underserved and rural populations, 5) expanding the scope of practice to include RxP would be good for the future of the field of psychology and, 6) RxP would be more convenient for patients.
As the percentage of respondents opposing RxP was quite low the absolute number of comments were smaller and are summarized here. For those opposing the pursuit of RxP the most common reasons, in order of frequency, were 1) concerns about patient safety, 2) expanding the scope of practice to include RxP would be bad for the future of the field of psychology, and 3) the opposition to RxP is too well funded and organized.
As a result of the clear support expressed in the survey of WSPA members and non-WSPA member psychologists, the WSPA Board made the decision in late March 2019 to officially endorse the pursuit of RxP legislation in our State. I believe the strong support evidenced in 2019 as compared to the equivocal support in 2007 is a result of several developments.
First, since psychologists have been prescribing successfully since the early 1990s more practicing psychologist across the entire field have become familiar and more comfortable with the concept of prescribing psychology.
Second, after the relatively rapid success of RxP laws in New Mexico and Louisiana, 2002 and 2004 respectively, there was a long period of failed attempts in multiple states, some defeated at the governor’s desk after passing both the Senate and Legislature (e.g., Hawaii and Oregon). Ongoing hard work by psychologists and other supporters lobbying for RxP across the nation resulted in several high profile wins in past few years including Illinois in 2014, Iowa in 2016 and most recently Idaho (our neighbor State) in 2017. While two States supporting RxP might be dismissed as an anomaly, five states represents a trend. Many are now considering the expansion of the scope of psychology practice to include prescribing as inevitable, if slow-paced.
Finally, practicing psychologists across the nation are recognizing that psychology is at risk of becoming less relevant in the healthcare marketplace and losing its identity to other well-organized, non-psychology professions. RxP may be seen by some as a way to further enhance our professional standing and set psychology apart from other encroaching fields. In the end, I believe prescribing psychology will eventually become a common subspecialty of psychology. We pursue this end because we believe that our patients deserve improved access to safe and effective psychiatric medication management, because the cost of not having this access (as measured in lives, psychological pain and loss of function) is unacceptable, and because we believe that prescribing psychologists’ safe track record demonstrates that we can be part of the solution.