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New Faces — New Opportunities |
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The National Perspective |
Pat DeLeon |
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Although it is currently impossible to predict with any sense of certainty which political party will ultimately be victorious in the national elections, obtaining control of the White House or both Houses of Congress, the 109th Congress will undoubtedly bring new faces and new policy agendas. With change always comes exciting opportunities and renewed challenges. I have been pleased with the extent to which our newest generation of psychologists has increasingly become personally involved in the public policy (i.e., political) process. This is where society’s priorities are established and where psychology’s future will ultimately be determined. Long-time California political operative Herb Dorken recently reflected: “My Senator is an oral surgeon representing a geographically huge northern California district. He was at one time I believe chief of the medical staff at our local hospital. Dr. Sam is Vice Chair of the Senate Health and Human Services Committee and is not termed out until 2010. He is also VP of Business and Professions and also sits on B & P’s subcommittee on the Future of the Health Care Professions. He is somebody CPA should work thru. Amazingly there are four psychologists in this year’s legislature. Senator Gloria Romero, a university professor, has taken a very public stance in trying to reform the Dept. of Corrections, badly needed. She is the Democratic Caucus Chair and is on the H & HS Committee where all our bills go and is not termed out until 2010. In the Assembly there is Dr. Judy Chu, Psy. D. from CSPP, LA, who is Chair of the Appropriations Committee where our bills go. Termed out in ‘06, if there’s a Senate opening, I’d be surprised if she didn’t go for it. She’s also a college professor. Dr. Leland Yee, a child psychologist, and former San Francisco Supervisor, co-authored AB 1091 this year. On his card he lists himself as Dr. Leland Yee. He is Speaker Pro tempore of the Assembly and is also on Appropriations and Business and Professional Committees (two psychologists on Appropriations!). Dr. Alan Lowenthal termed out this year, was Chair of Housing and Community Development, and also chaired the Select Committee on California Ports and is also a college professor. So all four psychologists are Democratic. I wonder what the November election will bring us in California? We’ll have at least three psychologists return.” Those individuals who become involved in the political process at the state and local level frequently evolve onto the national scene. Three of the four members of Hawaii’s current Congressional delegation began their political involvement in our State and/or Territorial legislature. Accordingly, we would urge the Division’s membership to take the time early on in 2005 to personally visit with each of your own elected officials, at both the local and national level. Every one of us is represented by one member in the U.S. House of Representatives and two U.S. Senators. For most of us, we also have the opportunity to vote for an individual in our State House and State Senate legislative bodies. The subject matter one selects for that meeting is not as important in the long run, as is the process of developing a mutually supportive relationship and open dialogue. Collectively, we must understand that very few elected officials (or health policy experts) truly appreciate the nuances of non-physician education. In the 108th Congress (2003-2004) the dominant professions continued to be law and business, with 59 members of the U.S. Senate possessing law degrees. These disciplines look at health care entirely differently than clinicians. They rely heavily upon personal experiences, public testimony, and the media for recommendations. If the national elections go well, there will once again be five psychologists serving in the U.S. House of Representatives. They will continue to make a real difference. Unfortunately, however, five psychologists in the 435 member House of Representatives does not really constitute the critical mass that our profession needs to ensure that “our voice is heard.” Grassroots involvement is critical. The Maturing Prescription Privilege (RxP-) Agenda: We have also been quite pleased with the steadily increasing and visual presence within organized psychology (and the public media at large) of those individuals who have completed their advanced training in clinical psychopharmacology. DoD graduate Elaine Mantell serves on the Committee for the Advancement of Professional Practice (CAPP), while DoD graduates Debra Dunivin and Morgan Sammons are the Division 55 APA Council of Representatives members. Their presence has definitely had an impact upon the ongoing policy RxP- dialogue within psychology, as well as upon society’s growing appreciation for the contributions of “psychologically-based psychopharmacology,” using Russ Newman’s conceptualization. Interestingly, in a recent Washington Post column stressing the benefits psychoactive medications can provide for depressed children, a board-certified child, adolescent, and adult psychiatrist in private practice noted: “Physicians who aren’t psychiatrists, as well as psychiatrists who don’t specialize in children, aren’t trained to evaluate or differentiate among varying psychiatric disease states in young people. And yet much of this medication is prescribed by family physicians or other non-psychiatric doctors. (In the future, psychologists – who are not medical doctors – may also have the right to prescribe medication. At least two states passed laws allowing this.) Moreover, these physicians don’t monitor the treatment closely, and changes in mood or behavior often go unnoticed....” The California Psychologist, is soliciting articles from RxP- training program graduates, for what should be a most impressive edition. Deborah Chandler of the APA Practice Directorate is ascertaining how many colleagues have actually graduated from an RxP- training program. Her preliminary data suggests that there are more than 400 graduates, with at least 262 currently receiving training. The Growing Interdisciplinary Nature Of Health Care: Morgan Sammons reports that within a few years, the number of non-physician health care providers in our nation is projected to approximate the number of physicians providing primary care. One of the underlying health policy themes raised by Herb’s reflections is his appreciation for the growing interdisciplinary nature of our nation’s health care system. Our next generation of professional psychologists will be working closely with colleagues who have been trained in a wide range of professional disciplines, especially as what we might traditionally consider “mental health” becomes increasingly integrated (as “behavioral health”) within a more generic health delivery scenario. As the unprecedented advances occurring in technology continue to directly impact upon health care and as educated consumers assume greater responsibility for their own personal care and health status, the behavioral sciences will become critical to ensuring “quality care.” In this light, we were delighted by the mailing from Native Hawaiian psychologist John Myhre describing the legislative priorities of the Waianae Coast Comprehensive Health Center, where he works. Specifically, his center was supporting legislation in the Hawaii legislature which would “Allow community health centers in State medically underserved areas to bill Medicaid/QUEST for dental visits provided by dentists with temporary state licenses.... (And) Allow for limited prescription authority for psychologists serving in State health professions shortage areas.” The RxP- agenda is having an impact. HPA Executive Director Carol Parker recently shared with her membership a “little ApA” Presidential message: “I am writing to solicit your advice and input regarding the issue of scope of practice: psychologist prescribing. As you are well aware, there are now two states that have legislatively given psychologists the right to prescribe – New Mexico and Louisiana. WE MUST PREVENT THIS FROM HAPPENING ELSEWHERE. I have appointed a Presidential Task Force... to provide the APA Board of Trustees, by December 2004, with a comprehensive short and long range set of strategies to address scope of practice issues. We are seeking your advice and consultation at this critical time. In addition to the commendable work that has been done by the APA to date, we are interested in knowing what you think must be done locally as well as nationally; the resources it will take and what you advise we do to secure or reallocate finances and personnel; and your ideas about strategy, both in the short term and long term....” Our collective voice is being heard. A View From Optometry: The RxP- agenda is fundamentally about ensuring that patients have ready access to the high quality health care that they deserve, from competently trained providers, in a cost-effective fashion. It is about patients making informed decisions about their own health. Those opposed to non-physician providers being involved in medication treatment decisions frequently proffer a highly emotional “public health hazard” argument, which essentially proclaims that patients will be affirmatively harmed, notwithstanding any objective data to support this position. During these legislative struggles, organized medicine generally supports the position of their related medical speciality colleagues. To our knowledge, it has been very rare for a non-affected non-physician discipline to become actively involved. And yet, the underlying public policy argument directly effects all of the non-physician disciplines. As The Wall Street Journal noted this Summer: “Getting Drugs Without the Doctor – States Extend Prescription-Writing Powers To Growing Range of Nonphysicians.... Scribbling out prescriptions was once a task reserved for doctors with years of specialized training. But a growing number of states are allowing health-care providers with less medical education – including pharmacists, certified midwives, and naturopaths – to prescribe drugs to patients.... The new laws are often supported by insurance companies, which stand to save money since they can reimburse nondoctors at lower rates. In some cases, major drug makers are also lobbying for new rules, although the industry is divided on the issue.... In one of the longest-running battles over prescribing authority, Louisiana’s governor signed a bill last month that will allow psychologists (whose training focuses on cognitive therapy, as opposed to medicine) to prescribe psychiatric drugs such as antidepressants and antianxiety medications, provided they get additional training in medicine and psychopharmacology. New Mexico passed similar legislation in 2002.” Within the Veterans Administration an initiative was recently begun allowing certain optometrists to utilize laser therapy, pursuant to the Oklahoma optometry scope of practice regulations. Not surprisingly, their medical counterparts (i.e., ophthalmology) sought “legislative relief.” From the American Optometric Association (AOA): “This week you are likely to be visited by ophthalmologists seeking support for HR 3473, the so-called Veterans Eye Treatment Safety Act of 2003. We urge you to keep the following in mind as you consider their arguments. * The procedures the bill questions are not surgery in the traditional sense, but procedures with a proven history of being performed safely and effectively by optometrists. As for laser surgery, contrary to what you may have heard, no optometrists in the VA are performing cataract, LASIK or any other truly invasive procedures. * The bill seeks to address problems that do not exist. No complaints have ever been filed against VA optometrists concerning laser use. Oklahoma optometrists have performed over 12,000 such procedures since 1998 with no patient complaints, no adverse outcomes and no litigation. * No VA optometrist obtains clinical privileges without a rigorous review by the medical establishment at the facility. To suggest that these medical doctors, who could in fact restrict privileges, are ignoring patient safety, defies logic and is not supported by any evidence. * The bill ignores time tested VA policy for credentialing and privileging of licensed independent practitioners and would single out optometrists for discriminatory treatment based solely on the unsurprising fact that a competing profession objects to their professional advancement. This would create a serious and dangerous precedent. * The bill would prohibit appropriately trained and licensed optometrists from performing not only therapeutic laser procedures, but such routine procedures as insertion of punctal plugs to treat dry eyes and removal of irritating eyelashes. * The bill would unnecessarily increase waiting time for care that has been competently provided by VA optometrists. Currently VA optometrists provide about 60 percent of the total eye care services to veterans annually. About 30 percent of VA medical facilities have optometrists only, 10 percent have ophthalmologists only, and 60 percent have both optometrists and ophthalmologists. The majority of VA optometrists are full time employees. Conversely, the majority of VA ophthalmologists are part time. By prohibiting VA optometrists from performing minor ophthalmic surgical procedures within their state scope of practice, veterans’ access to timely eye care would be compromised. Veterans would have to wait longer for care formerly provided by VA optometrists and they likely would have to travel greater distances to facilities having ophthalmology coverage. * Most importantly, this bill would trample on existing state licensing laws, and for the first time, inject the United States Congress into the traditional state role of licensing health professionals. Make no mistake – this is a turf battle between two professions that should be, and have been, rejected by those who understand the appropriate role of the states and the federal government on licensing issues and who understand and appreciate the VA credentialing process....” Optometry’s policy arguments closely parallel those of psychology. Attached to the AOA briefing memo was the transcript of a Public Radio commentary by a family practice doctor. “History tells us that any revolutionary movement will sooner or later succumb to the status quo. Alas, the specialty to which I’ve passionately given so much of myself has joined the Establishment.... The only reason I can imagine the AAFP has added its imprimatur to the document that petitions Congress to ban all surgery by optometrists is so that we can be seen standing together with our fellow doctors.... Medical organizations solemnly proclaim that the ruckus they’ve raised about laser eye surgery derives solely from their concern for the wellbeing of patients. But let’s give Lucre his due. These procedures pay well. Optometrists would probably do them for less than ophthalmologists; hence more competition; hence less money for physicians. As we used to say in the Sixties, Things will be better after the revolution. I’m old enough now to wonder which things and after which revolution.” The future has arrived. Aloha. |
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