A meta-analysis of opinion data on the prescription privilege debate.

Abstract

Abstract A meta-analysis of opinion survey data examined the attitudes of practicing psychologists, psychologists in training, and directors of clinical and internship training towards prescription privileges for psychologists. Three prescription-relevant statements were reviewed: (1) properly trained psychologists should be allowed to prescribe psychotropic medication; (2) APA should advocate in favour of prescription privileges for psychologists; (3) 1 would personally seek prescription privileges should such privileges be made available to psychologists. The results, based on 17 samples, showed minimal consensus and a general split of opinion on the advisability of pursuing the prescription privilege agenda. These findings suggest that prescription privileges have the potential to confuse issues of training and identity for future generations of psychologists. Compared to the natural sciences and medicine, psychology is a relatively new field. It was just a little over 120 years ago that Wilhelm Wundt (1837-1920) established the first psychological laboratory in Leipzig, Germany, and 104 years since Lightner Witmer (18671956) founded the first psychology clinic in Philadelphia, Pennsylvania. Like people, fields of scientific endeavour and clinical practice proceed through developmental stages, one of the more important being the formation of a personal identity. As a budding field looking for guidance in constructing a professional image, psychology has frequently turned to physics and medicine. Psychology's desire to gain acceptance as a science, along the lines of physics, has given rise to a plethora of conceptual mini-models that appear to have splintered psychological research and theory (Yanchar & Slife, 1997). Psychology's apparent ambition to achieve the stature of medicine, on the other hand, may have encouraged a growing acceptance of the medical model as exemplified by ongoing attempts by psychologists to obtain prescription privileges. Arguments offered in favour of prescription privileges for psychologists include: (1) lesser trained medical specialists like pharmacists and physicians' assistants are already prescribing psychotropic medication (Cullen & Newman, 1997), (2) prescription privileges would provide greater continuity of care and increased service delivery to underserved populations (DeLeon, Fox, & Graham, 1991), (3) physicians with no mental health expertise currently write 83%10 of the scripts for psychotropic medication (Zimmerman & Wienckowski, 1991), and (4) prescription privileges would enhance the income and professional status of prescribing psychologists (Healy, 1995). Some physicians oppose prescription privileges for psychologists on the grounds that prescribing psychologists would present a major health hazard (Aronoff & DeFries, 1992) although there is no evidence of harm in situations where psychologists have been allowed to prescribe (DeLeon et al., 1991; General Accounting Office, 1999). Arguments raised by psychologists against seeking prescription privileges take note of rising insurance premiums (Chatel, Lamberty, & Bierliaukas, 1993), atrophy of psychotherapy skills (DeNelsky, 1996), and growing alienation from psychology's roots and traditions as prescription privileges lead to increased acceptance of the medical model (Moyer, 1996). Given the relevance of the prescription privilege debate to both American (DeLeon et al., 1991) and Canadian (Dozois & Dobson, 1995) psychology, I conducted a meta-analysis of survey research related to psychology's pursuit of the prescription agenda. My purpose was to determine whether the opinions of practicing psychologists, psychologists in training, and directors of clinical and internship training were as polarized as views expressed in the literature. Attitudes towards this issue were captured in the metaanalysis by three general statements found in the survey data: (1) properly trained psychologists should be allowed to prescribe psychotropic medication; (2) APA should advocate in favour of prescription privileges for psychologists; (3) 1 would personally seek prescription privileges should such privileges be made available to psychologists. …