Government Accounting Office Report on
Federal Psychologists' Prescribing Pilot Project Concludes It is a Failure
Proponents of Senate Bill 2050 have raised the idea of creating a pilot
project to determine whether psychologists can be adequately trained to
write prescriptions under certain circumstances.
On April 1, in its final report on a 6-year federal pilot project, the
federal Government Accounting Office (GAO) answered that question with a
definitive NO in its 30-page final program audit report titled: "NEED
FOR MORE PRESCRIBING PSYCHOLOGISTS IS NOT ADEQUATELY JUSTIFIED."
In 1991, Congress established a psychologists' prescribing pilot program
in the Department of Defense called the Psychopharmacology Demonstration
Project (PDP). The program ran for approximately 6 years. Training began
in August, 1991 and the last graduates will complete training in June, 1997.
Program graduates received 3 years of full-time formal training: one year
of classroom instruction, one year of clinical training, and one year of
proctored practice, yet they still must practice under the close supervision
of a psychiatrist.
In its program audit report, the GAO concluded that: "Given DOD's readiness requirements, the PDP's substantial
cost and questionable benefits, and the project's persistent implementation
difficulties, we see no reason to reinstate this demonstration project."
GAO noted that " The MHSS
[Military Health Services System] originally anticipated that these psychologists
would ultimately function independently. All of the PDP graduates, however,
continue to practice under the supervision of a psychiatrist, and whether
they will ever prescribe independently is unclear." Further,
their scope of practice is limited to patients between the ages of 18 and
65 who have mental conditions without medical complications as determined
by their supervising psychiatrists. And that is
after 3 years of full-time training!
The GAO auditors stated: "although training psychologists
to prescribe medication enables them to perform functions they do not
normally perform, it does not give them all the skills needed to enable
them to substitute for psychiatrists....Therefore' the MHSS seems to
have no current or upcoming need for psychologists who may prescribe drugs."
The auditors also noted that "The PDP Advisory Council's February 1995
scope of practice statement, which has been used as guidance for allowing
prescribing privileges for some PDP graduates, states that prescribing psychologists
should prescribe psychotropic medications only under the direct supervision
of a physician. According to the Advisory Council
that developed this statement,
PDP graduates' prescribing practice should be
"closely supervised" by a physician.
The GAO auditors pointed out that: "To practice medicine,
psychiatrists complete 4 years of medical school and a 1-year clinical internship
during which they are trained to evaluate and treat all types of organic
conditions and to perform general surgery. After this, they complete a 3-year
psychiatric residency during which they learn to evaluate and treat mental
conditions and the organic conditions associated with them. Because psychiatrists
practice medicine, they can diagnose organic as well as mental conditions
and treat each with medication. They consider a full range of possible organic
causes for abnormal behavior when diagnosing a condition. Therefore, they
can distinguish between mental conditions with an organic cause, such as
schizophrenia and bipolar disorder, and organic conditions, such as diabetes
and thyroid disease, which have symptoms that mimic a mental disorder. Organic
mental disorders are best treated through a combination of medication and
psychotherapy, according to DOD officials."
By contrast, "psychologists are trained in theories of human development
and behavior, so their general approach to diagnosing and treating mental
illness is psychosocial rather than medical. They are trained to diagnose
and treat all mental conditions and rely on the behavior a patient displays
to diagnose these conditions."
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