FAQs | Texas RxP

Go ahead; It's OK to ask...

Do you really think psychologists are qualified to prescribe?

No. But we think psychologists with an extra three years of specialty training are.

Three years? I thought y'all wanted to just take a class or two to be able to prescribe?

Nope. It takes us three years to get this extra training - sometimes more. A Master of Clinical Psychopharmacology (MSCP) is a degree designed specifically for doctoral-level psychologists that focuses 100% on the knowledge that psychiatrists and other physicians have deemed to be appropriate to train safe and effective prescribers. After spending two years obtaining that degree (and the prereqs that may be required to even get into the program), we then spend a year (more than most nurse practitioners do) precepting under the close supervision of a prescriber.

Why not go to Nurse Practitioner school?

This does seem like a great idea at first. But on closer inspection, there are two problems. The first problem is that nursing school is designed for an entirely different purpose and population. Some courses make sense for psychologists and would be quite helpful to prescribe. Other courses, however, are either completely irrelevant, would have us away from our patients (who need us) for several days out of the week learning to do hands-on tasks that prescribing psychologists should never do (giving shots, inserting catheters, and supporting labor and delivery will always be well outside of our scope of practice). Or, on the other hand, there are some courses that we ourselves are already qualified to teach (research, statistics, public health, clinical interviewing, diagnosis, and evaluation, etc.). The benefit of a specialty program specifically for psychologists is that program developers (usually psychiatrists, physicians, and pharmacists) have collaborated to make the program fit our unique pre-existing level of training. For example, neuroanatomy, neurochemistry, clinical assessment, medical ethics, etc., can all start well above the basics, since psychologists already have foundational training (sometimes expertise) in these areas. This approach also permits an intensive study schedule that also allows us to continue seeing our current patients, as well.

But what if the training isn't enough... what about safeguards?

First, this isn't new. Prescribing psychology dates back to the '80s (yes you read that right, the eighties!). Psychologists have been prescribing in the military and our neighboring states (Louisianna and New Mexico) for decades. Can a "lack of incidence" be taken as evidence of success or safety? That's hard to answer. However, given that organized psychiatry has been opposed to allowing us to help, if our ability to prescribe within the military and (currently) five states had led to negative outcomes, we can only imagine that it would be a routine talking point.

Second, we know that the current process isn't safe (primary care providers write 80% or more of psychiatric medications). Research is fairly clear on this point. Inaccurate diagnoses are made left and right, wrong medications are prescribed, overmedication is a pandemic all its own, and drugs are constantly being abused without close monitoring. If there's one thing we know how to do, even without additional training, it's helping patients land at the right diagnosis (often, even helping physicians differentiate between physiological and psychological).

Finally, and MOST IMPORTANTLY, we know of no legislative proposal in the United States that does not - in some way or another - require a prescribing psychologist to communicate with a patient's primary care provider. This means not only does the patient have four eyes instead of two overseeing their psychiatric medications, but that collaboration is increased between mind and body - something we've known needs to happen more often for decades.

Are physicians on board with this?

Clearly, we have a "physicians" page because "it's complicated." While it's hard to speak in generalities, here's the short version:

Research shows that organized psychiatry is the most strongly opposed group to psychologists prescribing. In their defense, we understand that they care about their patients, and they may have understandable concerns. But we do not think that the research backs up this concern.

Research shows that primary care physicians are less opposed to psychologists prescribing. Qualitative interviews indicate that primary care physicians generally advocate for psychologists to be able to lift the burden on them and handle psych-related treatment. As one physician said in an interview "you guys know more about the diagnoses and even the medications than I do!"

Most importantly, physicians who actually work with prescribing psychologists are beyond supportive. While there are only a few studies demonstrating this, both quantitative and qualitative studies make it clear that physicians are impressed when they work side by side with a prescribing psychologist. We have never (as in, never ever) met a physician who has worked with a prescribing psychologist who was not supportive. If you meet anyone opposed to RxP, ask them how many prescribing psychologists they have directly worked with.