Health

Prescribing authority for psychologists moves forward in Iowa, but still faces opposition

A prescription being filled. (Stephen Mally/The Gazette)
A prescription being filled. (Stephen Mally/The Gazette)

An effort to fill a gap in mental health care services in Iowa nearly has reached the two-year bench mark in its planning process, but some continue to oppose the move, citing potential negative patient outcomes.

The Iowa Board of Medicine heard comments in Des Moines Tuesday during a joint rule-making public meeting with the Iowa Board of Psychology to allow certain psychologists in Iowa the authority to prescribe psychotropic medications.

State legislation from 2016 gives prescriptive authority to Iowa-licensed psychologists who have completed required education and advanced, supervised training.

They also will have to complete a two-year period of conditional prescribing under a physician’s supervision.

Once their training is completed and they have successfully undergone the conditional period, certified psychologists independently can prescribe medications — except narcotics — to patients while collaborating with a primary care physician.

Formal meetings on these administrative rules have taken place for the past 18 months.

“As a profession, we care about the well-being of our patients as well,” said Dr. Elizabeth Lonning, a Davenport-based licensed psychologist who supports the initiative. “We are certainly not interested in doing any harm or in being unsafe or anything of that nature. We want what’s best for our patients.”

The changes were endorsed to expand services for mental and behavioral services that some Iowans currently struggle to find, in part due to a shortage of psychiatrists in the state.

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In a letter to the boards of medicine and psychology, Iowa’s federally qualified health centers and the Iowa Primary Care Association voiced their support of the new rules.

They emphasized behavioral-health professional recruitment is very challenging for providers, and “having access to a qualified, trained workforce is essential” in filling that gap.

“These rules move us closer to providing even better patient care,” the letter said.

However, some medical professionals are pushing back.

“The (Iowa) Medical Society was opposed to original legislation and we continue to believe that this is not a safe method of expanding access to behavioral health services in the state,” said Dennis Tibben, the society’s director of government affairs.

Psychologists, such as psychiatrists, are primarily based in urban settings, according to the American Medical Association — data that Tibben pointed to as an indicator that allowing psychologists to prescribe medication will not address rural access issues.

Instead, Tibben said, the medical society supports the increased use of telemedicine.

But a main concern of the Iowa Medical Society and other physician groups is that the training requirements are not strong enough, according to written comments submitted to the Board of Medicine this week, which could negatively affect patient outcomes.

However, the Iowa Mental Health Planning Council, in a letter to the boards this week, stated that “great care has been taken in outlining a pathway for psychologists to be able to prescribe.”

Lonning, the Davenport psychologist, agreed, adding that professionals interested in this training already are licensed psychologists — meaning they are licensed to independently treat and diagnose people with mental health disorders.

“We’re not asking to prescribe the entire amount of medication that a physician assistant can prescribe,” Lonning said. “We’re only asking to be allowed to prescribe those within our scope of practice in terms of psychologists.”

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In addition, physicians in the public comment session pointed out that their specialization often does not have a great depth of experience with psychotropic medications prescribed to patients, such as lithium. Instead, psychiatrists would be best to oversee those psychologists, organizations recommended.

Both the Board of Medicine and the Board of Psychology will vote on the rules as written in their upcoming meetings later this month and next month. It’s uncertain at this time, if approved, when the rules will be implemented.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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