Protect patients by rejecting 'RxP'

Opinion: Columns

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By Lisa Rone, M.D. & Peter Fore, M.D.

As longtime Oak Park residents, we respect state Sen. Don Harmon and consider him a forward-thinking, progressive legislator. But as doctors, we are troubled by Sen. Harmon's support for a bill that would allow psychologists — who have no medical training — to prescribe medication. The Illinois Senate passed this legislation last year before it foundered in the House. Sometimes called "RxP," the bill is certain to resurface this year.

In any policy discussion regarding medical treatment, the interests of patients must come first. This bill, if passed, would put patients at risk. 

Like other doctors who specialize in psychiatry, we went through nine years of medical training before we were able to prescribe medication for mental illness. RxP, if it became law, would let psychologists have this power after 425 to 450 hours of training, which could be completed online. It would replace nine years of training with five months of it.

Imagine if we allowed people to perform root canal after taking an online course; imagine if we allowed vets with only online training to treat our pets. RxP would do something akin to this in the treatment of mental illness. It would, in effect, say that a lower standard of treatment is acceptable for those who suffer from mental illness.

Maybe that is why the nation's pre-eminent mental health advocacy organization — the National Alliance for Mental Illness — opposes RxP. The Illinois chapter of this national organization has also come out against the bill.

Under current law, physician assistants, nurse practitioners and advanced practice nurses — all of whom have medical training — can prescribe medication under a collaborative agreement with a physician. Medically trained professionals understand the relationship between the body and the brain. During their training, they treat infants and the elderly, they attend at births and deaths, and they see the extremes of life. They learn the importance of treating the whole patient. 

To truncate that training in one fell swoop, with the passage of RxP, would be a grave mistake. Some of the most powerful drugs in modern medicine, drugs used to treat bipolar illness and schizophrenia, can create dangerous side effects as well as risky interactions with other drugs and pre-existing medical conditions. It is of the utmost importance that this bill not become law.

RxP's proponents assert that the bill expands access to mental health care by allowing more psychologists in rural and underserved communities to prescribe. That is false. Few psychologists practice in underserved areas, and there are safer, more effective solutions for administering mental health care in remote regions of the state. One solution is "tele-psychiatry," which uses videoconferencing for counseling and treating patients. There are also collaborative, integrated health-care models that would increase access to mental health care without putting patients at risk. 

Working together, we need to address the shortage of mental health services in some parts of our state. As psychiatrists, we are committed to being part of the solution, as are many of our fellow physicians. But in crafting a solution, we must be mindful of our obligation to do no harm. The interests of patients and their families must come first — before those of any particular professional group.

Dr. Rone practices psychiatry in Chicago and is clinical assistant professor of psychiatry at Northwestern University. Dr. Fore practices psychiatry in Chicago and is clinical associate professor of psychiatry at the University of Illinois.

Reader Comments

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Dr.Fanibanda, Darius from los gatos, CA  

Posted: March 28th, 2014 11:25 AM

When well educated profeessionals fight for turf, it must be hard for the consumer t o decide who is right and who is wrong. This is a fight for turf, not about training.

Robert from Melrose Park  

Posted: March 24th, 2014 3:01 PM

Here are the facts: Prescribing psychologists earn a Master's in psychopharmacology in addition to the PhD. This Master's consists of 2 years of in-classroom medical education plus 500 hours of practicum. A 2-year conditional period follows under supervision of a physician. Finally, these specialty psychologists prescribe only with a written collaborative agreement with a physician, just like nurse practitioners. The time has come to improve access to mental health care in IL and pass this bill

Jon from Long Beach  

Posted: March 24th, 2014 2:52 PM

Prescribing psychologists typically train for 10-12 years after graduating college, including training in ordering and interpreting labs, physical assessment, and diagnosis. Arguments against RxP are based on the desire of psychiatrists and other MDs to maintain their economic turf. Psychologists have a twenty year record of safe prescribing, and can help the mental health system return to a better balance between medical and psychological interventions.

ATS from Chicago  

Posted: March 24th, 2014 12:14 PM

I understand that psychologists have already been prescribing psychiatric medications in several states and in the military for many years. There have been no safety problems and its led to better and assessable care for underserved people. Good for Sen Harmon for addressing a serious patient accessibility problem with a proven and effective expansion of prescription authority for trained psychologists. If this idea was good enough for US military it will be good for the people of Illinois.

Improve access  

Posted: March 7th, 2014 12:56 PM

The one piece of the puzzle being missed here is improving access to mental health care. Especially for patients who may not be able to afford, or be comfortable seeing, the full range of professionals. It IS about the patient, but not just safety. It's about wider opportunities to be seen. I'm fully in favor of the proposal. "No medical training" is being slightly false about the neuroscience knowledge that psychologists are required to have. Let them write.

OP Res253 from Oak Park, Illinois  

Posted: March 7th, 2014 12:29 PM

That is a ridiculously facile reading of the proposal by a practitioner who wants to preserve his value (which I understand). This is not the equivalent of a non-dentist performing a root canal. It is a non-dentist cleaning, scraping and applying sealant under the supervision of a dentist. Which is done ALWAYS. Nurse's pass anesthesia, many meds are over the counter. There are many drugs classes that a PhD phsch can likely provide as well as, or better due to patient interaction than, an


Posted: March 7th, 2014 10:29 AM

This is a completely bogus policy position that must have some other motivation than helping the mentally ill. Any intelligent person can understand why only trained medical professionals should be prescribing prescription medications. I wonder how much time Harmon spent on this when he should have been focusing on pension reform? Not a good use of his time & my tax payer $. Harmon has opposition in the democratic primary. This just adds to the list of reasons I won't be voting for him!

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