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Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

Published online by Cambridge University Press:  06 January 2021

Brent Pollitt
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Extract

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.

The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

Type
Research Article
Information
American Journal of Law & Medicine , Volume 29 , Issue 4 , December 2003 , pp. 489 - 524
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2003

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References

1 DEPARTMENT OF HEALTH AND HUMAN SERVICES, MENTAL HEALTH: A REPORT OF THE SURGEON GENERAL 45 (1999), available at http://www.surgeongeneral.gov/library/mentalhealth/pdfs/C2.pdf.

2 Here, primary care physician includes family and general practice physicians.

3 See Martin, Sara, DeLeon Elected APA President for 2000: His Agenda Calls for Implementing Others ‘Good Ideas,’ 30 APA MONITOR 1 (Jan. 1999)Google Scholar (quoting American Psychological Association president as saying that “[e]ighty percent of the prescriptions written for mental health disorders are written by physicians with little or no mental health training”), available at http://www.apa.org/monitor/jan99/pat.html; Walters, Glenn D., A Meta-Analysis of Opinion Data on the Prescription Privilege Debate, 42 CAN. PSYCH. 119–120 (May 2001)CrossRefGoogle Scholar (stating, “physicians with no mental health expertise currently write 83% of the scripts for psychotropic medication”) (citing Zimmerman, Marc A. & Wienckowski, Louis A., Revisiting Health and Mental Health Linkages: A Policy Whose Time Has Come… Again, 12 J. PUB. HEALTH POLICY (1991) 510–524)CrossRefGoogle Scholar.

4 See AMERICAN PSYCHIATRIC NURSES ASSOCIATION, PRESCRIPTIVE AUTHORITY FOR ADVANCED PRACTICE PSYCHIATRIC NURSES, at http://www.apna.org/resources/positionpapers.html (Sept. 15, 1995) [hereinafter APNA PRESCRIPTIVE AUTHORITY]; AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS, INFORMATION ON PAS AND THE PA PROFESSION, at http://www.aapa.org/geninfo1.html (last visited Nov. 9, 2003) [hereinafter AAPA INFORMATION].

5 See AMERICAN SOCIETY FOR THE ADVANCEMENT OF PHARMACOTHERAPY, WEEKLY READER #112, at http://www.apa.org/divisions/div55/WR112.html (Sept. 10, 2001) (“Pharmacists now have prescriptive authority in 27 states using a defined protocol developed for each patient by the attending physician.”); CALIFORNIA PSYCHIATRIC ASSOCIATION, PSYCHOLOGIST PRESCRIBING BILLS PSYCHOLOGISTS’ CLAIMS VS. REAL FACTS, at http://www.calpsych.org/legislation/1999/claimvsfact.html (Mar. 3, 1998) [hereinafter CPA PSYCHOLOGIST PRESCRIBING].

6 Here, the term “psychologist” refers to doctorate level practitioners, which includes “clinical” psychologists. The group “clinical psychologists” occasionally includes those with doctoratal degrees in education counseling and school psychology, but in this Article the terms precludes those degrees.

7 See Nancy Ann Jeffrey, Psychologists Demand Power to Prescribe, WALL ST. J., Apr. 10, 1998, at B1 (“Psychologists are increasingly fixated on one of psychiatrists’ most valuable assets: the prescription pad.”).

8 The American Society for the Advancement of Pharmacotherapy (“ASAP”) is a division of the American Psychological Association, which “was created to enhance psychological treatments combined with psychopharmacological medications.” ASAP, at http://www.apa.org/divisions/div55/ORGchrs.html (last visited Nov. 9, 2003).

9 The American Psychological Association (“APA”) has more than 150,000 members, making it the largest association of psychologists worldwide. APA, at http://www.apa.org (last visited Nov. 9, 2003).

10 See infra Part III.

11 AMERICAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY, DOD PRESCRIBING PSYCHOLOGISTS: EXTERNAL ANALYSIS, MONITORING, AND EVALUATION OF THE PROGRAM AND ITS PARTICIPANTS, 6 ACNP BULL. (Summer 2000), available at http://www.acnp.org/pdffiles/vol6no3.pdf [hereinafter ANCP DOD].

12 See N.M. STAT. ANN. § 61-9-17.1 (repealed effective July 1, 2010) (indicating 450 didactic hours and a total of 480 hours of clinical internship hours comprise the total 930 hours of the program); APA, NEW MEXICO GOVERNOR SIGNS LANDMARK LAW ON PRESCRIPTION PRIVILEGES FOR PSYCHOLOGISTS, available at http://www.apa.org/practice/nm_rxp.html (Mar. 6, 2002) (stating that New Mexico requires psychologists to complete 450 hours of coursework, a 400 hour/100 patient practicum under physician supervision, and pass a national certification examination) [hereinafter APA Press Release].

13 See Bill Granting Psychologists Prescription Authority Moves Forward, 8 CAL. HEALTH L. MONITOR 2 (June 26, 2000)Google Scholar. See also, Charles E. Holzer III et al., The Availability of Health and Mental Health Providers by Population Density, Letter to the Field No. 11, at http://www.wiche.edu/MentalHealth/Frontier/letter11.html (last visited Nov. 9, 2003) (discussing the availability of mental health care providers in rural America); Dennis F. Mohatt, Access to Mental Health Services in Frontier America, Letter to the Field No. 4, at http://www.wiche.edu/MentalHealth/Frontier/letter4.html (last revised Nov. 4, 1997) (discussing the shortages of health care providers in rural America).

14 ASAP, WEEKLY READER #115, at http://www.apa.org/divisions/div55/WR115.html (Oct. 21, 2001) (“The ‘split’ treatment model where one professional prescribes, and another provides the treatment and monitors the medical [sic] requires extra appointments at an extra cost and added inconvenience to the patient. Delays in treatment complicate recovery and add to costs.”).

15 The APA is a medical specialty society recognized world-wide. Its 37,000 U.S. and international physicians specialize in the diagnosis and treatment of mental and emotional illnesses and substance use disorders. AMERICAN PSYCHIATRIC ASSOCIATION, at http://www.psych.org/aboutapa.cfm (last visited Nov. 9, 2003). See also Andrew Julien, M.D.s, Ph.D.s Prepare for Battle: Psychologists Asking Legislature's Approval to Dispense Medicine, HARTFORD COURANT, Feb. 27, 2001, at A1 (quoting John Winston Bush, as stating prescriptive authority for psychologists “would undermine psychology's historic reliance on talk-therapy and other strategies to confront emotional and behavioral problems”)

16 PHYSICIAN's WEEKLY, POINT/COUNTERPOINT: SHOULD PSYCHOLOGISTS HAVE PRESCRIBING PRIVILEGES?, at http://www.physweekly.com/archive/01/07_02_01/pc.html (July 2, 2001) (stating viewpoint of president of the APA).

17 Id.

18 Id.

19 Julien, supra note 15. See generally COGNITIVE BEHAVIOR THERAPY, at http://www.cognitivetherapy.com/index.html (updated Nov. 5, 2002).

20 Jack M. Geller, The Role of Rural Primary Care Providers in the Provision of Mental Health Services: Voices from the Plains, Letter to the Field No. 10, at http://www.wiche.edu/MentalHealth/Frontier/letter10.html (last visited Nov. 9, 2003); Jack M. Geller & Kyle J. Muus, The Role of Rural Primary Care Physicians in the Provision of Mental Health Services, Letter to the Field No. 5, at http://www.wiche.edu/MentalHealth/Frontier/letter5.html (last visited Nov. 9, 2003). See also infra Part IV.A.

21 See infra Part IV.C.

22 ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf (finding that the training program could transform licensed clinical psychologists into safe and effective prescribing psychologists, and suggesting that the participants performed well with the focus of the PDP on “the training of clinical psychologists in preparation for limited prescribing privileges”).

23 See infra Part V.C. The study involved an extremely small, non-representative, military population under ostensibly laboratory settings, pre-screening patients for non-psychological health problems, prohibiting treatment of children and the elderly, with the prescribing psychologists completing more than double the education and training currently required.

24 PHYSICIAN's WEEKLY, supra note 16, at http://www.physweekly.com/archive/01/07_02_01/pc.html (quoting Russ Newman, Ph.D., J.D., Executive Director for Professional Practice, American Psychological Association).

25 See infra Part V.B.

26 See infra Part III. (detailing the weight given to non-medical, behavioral sciences by undergraduate and graduate psychology degree programs).

27 APA, PRESCRIPTIVE AUTHORITY FOR PSYCHOLOGISTS: AN UPDATE FROM APA, at http://www.apa.org/apags/profdev/rxpauthority.html (Winter 2002) (discussing, in part, the PDP study's findings that psychologists can be effectively trained to prescribe safely).

28 See, e.g., Judith Felson Duchan, Graduation Speech, Learning and Leveling Learning, available at http://www.acsu.buffalo.edu/∼duchan/leveling.html (May 12, 2001) (describing the medical model as “a way of thinking…[that presumes] that the physician's task is to diagnose diseases, to discover their causes and symptoms, and design treatments… . The medical model is made up of causal chains, of primary, secondary, and tertiary causes.”).

29 Compare infra Part II.C., with infra Part III.

30 Cf. infra Part III. (referring to psychologists’ lack of medical training).

31 See infra Part V.D. (arguing that a grant of prescriptive authority to psychologists cannot overcome social and geographic impediments to care).

32 E.g., SOUTH CAROLINA STATE BUDGET AND CONTROL BOARD, OFFICE OF RESEARCH & STATISTICS, SOUTH CAROLINA RURAL HEALTH REPORT, at http://www.ors2.state.sc.us/rural_health.asp (last visited Nov. 9, 2003) (describing the largest towns in rural communities as having populations of less than 25,000 as compared to populations of 10,000 or less in the largest towns in very rural communities).

33 See infra notes 159-60, 169-71 and accompanying text. This statement assumes perfect distribution of only one psychologist or physician per county.

34 See infra note 288, 292 and accompanying text.

35 See generally, Courtenay M. Harding et al. Problems Faced by Consumers of Mental Health Services out in a Frontier Community; Letter to the Field No. 23, at http://www.wiche.edu/MentalHealth/Frontier/letter23.html (last visited Nov. 9, 2003).

36 See infra Part V.E.

37 See Jack G. Wiggins, Increasing Access to Mental Health Care, Improving Quality of Care and Reducing Costs through Prescriptive Authority for Licensed Psychologists with Specialty Training, at http://www.apa.org/divisions/div55/AHCCCS.htm (last visited Nov. 13, 2003) (discussing cost saving potentials for the state of Arizona if psychologists were granted prescriptive authority). See also infra Part V.E. for a discussion on whether granting psychologist prescriptive authority will reduce costs generally.

38 ASAP, WEEKLY READER #123, at http://www.apa.org/divisions/div55/WR123.html (Feb. 7, 2002) (quoting survey results of Brian Ramirez, doctoral candidate at Wright State University).

39 Id. “Only 6% of respondents disagreed or strongly disagreed and 9% were neutral.” Id. Fifty-five percent of the same psychologists “agreed or strongly agreed that they would be willing to pay higher malpractice rates for RxP [prescriptive authority].” Id. Only “30% disagreed or strongly disagreed with the statement, and 15% were neutral.” Id.

40 While the New Mexico law allows prescribing psychologists to order necessary tests, many of these psychologists will have to order blood tests, urine tests, electroencephalograms, electrocardiograms, and the like, outside of their office. Family practice physicians’ offices are set up to conduct many such tests without requiring an additional office visit. See infra Part V.E., for a discussion on the difficulty patients and psychologists will face if patients’ mental illnesses require additional medical intercession.

41 Who will monitor medication for patients requiring maintenance treatment? Patients will likely see their family physicians more often than their psychologists after treatment, yet patients will now have to see their psychologists, on separate appointments, and miss work for medication level monitoring. In addition to reducing costs, physicians are the better choice for this monitoring because of their expertise. This becomes even more evident for patients requiring blood serum level monitoring (e.g., mood stabilizers such as Lithium, Carbamazepine, or Divalproex). See John Preston, Quick Reference to Psychotropic Medication, 2003 Update, ASAP, available at http://www.apa.org/divisions/div55/PrestonMedicationCard2003.pdf (last visited Nov. 9, 2003). See infra Part V.E., for a discussion on the probability patients will have to see both a psychologist and a physician if the former prescribes medication.

42 Wiggins, supra note 37, at http://www.apa.org/divisions/div55/AHCCCS.htm.

43 See infra Part V.E., for a discussion on increased patient costs as a result of additional medical appointments and the likelihood that psychologists will increase their fees to offset the expense of their additional education and increased liability.

44 See, e.g., Myrle Croasdale, Prescribing Rights Dominate Scope-of-Practice Bills: The Debate Over Passage Pits Psychiatrist Against Allied Professionals, AM. MED. NEWS, available at http://www.ama-assn.org/amednews/2003/04/14/prsc0414.htm (Apr. 14, 2003) (“Even in Chicago's suburbs, the wait to see a psychiatrist is six weeks to two months.”); Andis Robeznieks, Psychologists See Rural Areas as Entry Point to Prescribing, AM. MED. NEWS, available at http://www.ama-assn.org/amednews/2002/12/02/prl21202.htm (Dec. 2, 2002) (“With less than a dozen psychiatrists to serve the rural communities in the western part of the state, officials with both the Nebraska Medical Assn. and Nebraska Psychiatric Society acknowledge that the state is in the midst of a mental health crisis—in both rural and urban areas.”).

45 See Wiggins, supra note 37, at http://www.apa.org/divisions/div55/AHCCCS.htm (“Psychology is proposing to enhance the quality of mental health services and expand access to care by integrating cognitive behavioral therapy with psychopharmacology. This is known as the ‘best practices’ model of mental health treatment since it combines the two forms of treatment demonstrated to be effective.”). Wiggins’ description of combining talk therapy with psychopharmacology is the job description of a psychiatrist. See infra Parts V.E.-F., for mention of the best practice model and the role of psychiatrists in the healthcare profession.

46 See infra Parts II.A., III, and V.B., for a comparison of educational and experiential requirements for psychiatrist and prescribing psychologists.

47 See Holzer et al., supra note 13, at http://www.wiche.edu/MentalHealth/Frontier/letter11.html (discussing distribution of mental health providers by population, indicating high employment overlap for health care providers in heavily populated geographical areas, moderate overlap in suburban areas, and the absence of psychiatrists, the paucity of psychologists, and virtual non-existence of family practice physicians in one-third of counties for very rural areas); infra Part IV.A. (comparing practitioners in metropolitan and non-metropolitan areas).

48 See Letter from E. Mario Marquez, Clinical Psychologist, to Gary E. Johnson, Governor, New Mexico, ASAP, available at http://www.apa.org/divisions/div55/RxPResources.htm (Feb. 23, 2002) (citing a September 2000 article in the Albuquerque Journal stating that “22 child psychiatrists have left New Mexico, leaving the state with a number that is half the national average,” and “the NM Psychiatric Association's membership declined by about 50 psychiatrists during the previous five years”). Psychiatrists are already leaving some less populated states such as New Mexico. Regardless of why these psychiatrists chose to leave, increasing competition will only cause more to leave. See infra Part V.F. (discussing the effect on other mental healthcare providers).

49 See Holzer et al., supra note 13, at http://www.wiche.edu/MentalHealth/Frontier/letter11.html.

50 See infra Part V.F.

51 See infra Parts II.B.-C. (indicating physician assistants and nurse practitioners require the least amount of training while possessing some psychopharmaceutical prescriptive authority).

52 See infra Part V.F.

53 See infra text accompanying notes 239-40, 250-55.

54 N.M. STAT. ANN. § 61-9-17 (repealed effective July 1, 2010). See also APA Press Release, supra note 12, at http://www.apa.org/practice/nm_rxp.html.

55 See infra text accompanying notes 297, 302, 314-15.

56 To work under a physician, psychologists should be required to complete the same prerequisites, course work, and clinical practicum experience required for physician assistants. See infra text accompanying notes 85-87. Alternatively, psychologists should be required to complete the same prerequisites, course work, and clinical practicum experience required for nurse practitioners. See infra text accompanying notes 92-94, 96, 98. Readers should take the phrase “prescribe independently” to mean that 10% of all prescriptions made are reviewed by a physician who may alter the prescription. Similar regulations applying to nurses with prescriptive authority should apply to psychologists. See infra notes 102-03 and accompanying text.

57 See, e.g., CAL. BUS. & PROF. CODE § 2501 (West 2003). In this Article, the term “physician” includes allopathic and osteopathic practitioners, and the term “psychiatrist” includes all sub-specialties within the field.

58 Id.

59 See infra notes 82-83, 100-05 and accompanying text.

60 Compare STANFORD UNIVERSITY, SCHOOL OF MEDICINE CATALOG, MD PROGRAM, available at http://www.med.stanford.edu/school/catalog/bookone/mdprogram.html (last visited Nov. 9, 2003) [hereinafter STANFORD MD PROGRAM], and STANFORD UNIVERSITY, SCHOOL OF MEDICINE CATALOG, MD CURRICULUM, available at http://www.med.stanford.edu/school/catalog/bookone/mdcurriculum.html (last visited Nov. 9, 2003) [hereinafter STANFORD MD CURRICULUM], with UNIVERSITY OF CALIFORNIA SAN DIEGO, SCHOOL OF MEDICINE, CATALOG, 2002-03, available at http://meded.ucsd.edu/Catalog/56.html (last visited Nov. 9, 2003) (requiring similar prerequisites— chemistry, biology and physics—and similar graduation requirements) [hereinafter UCSD MEDICINE CATALOG].

61 See, e.g., SAN DIEGO STATE UNIVERSITY CATALOG, SPRING 2002 CLASS SCHEDULE, available at http://www.sdsu.edu/cgi-bin/schedule/semester=spring02 (last visited Nov. 9, 2003) (indicating prerequisite courses for medical school require 40 units of science course work) [hereinafter SDSU CATALOG SPRING 2002].

62 E.g., STANFORD MD PROGRAM, supra note 60, at http://www.med.stanford.edu/school/catalog/bookone/mdprogram.html; STANFORD MD CURRICULUM, supra note 60, at http://www.med.stanford.edu/school/catalog/bookone/mdcurriculum.html.

63 E.g., UCSD MEDICINE CATALOG, supra note 60, at http://meded.ucsd.edu/Catalog/56.html.

64 Id.

65 “The Medical College Admission Test (MCAT) is a standardized, multiple-choice examination designed to assess problem solving, critical thinking, and writing skills in addition to the examinee's knowledge of science concepts and principles prerequisite to the study of medicine. Scores are reported in each of the following areas: Verbal Reasoning, Physical Sciences, Writing Sample, and Biological Sciences.” ASSOCIATION OF AMERICAN MEDICAL COLLEGES, ABOUT THE MCAT, at http://www.aamc.org/students/mcat/about/start.htm (last visited Nov. 9, 2003).

66 “In 2000, the average GPA for medical school matriculants [was] 3.6, continuing an upward trend since the 1980s. MCAT scores for each of the testing categories (verbal reasoning, physical sciences, and biological sciences) [were] either on par or better than last year.” AMERICAN ASSOCIATION OF MEDICAL COLLEGES, U.S. MEDICAL SCHOOL APPLICANTS STILL EXCEED AVAILABLE POSITIONS: UNDERREPRESENTED MINORITY APPLICANTS INCREASE FOR THE FIRST TIME SINCE 1996, at http://www.aamc.org/newsroom/pressrel/2000/001025.htm (Oct. 25, 2000).

67 E.g., STANFORD MD CURRICULUM, supra note 60, at http://www.med.stanford.edu/school/catalog/bookone/mdcurriculum.html (listing the course requirements on range of courses in human physiology and biology, including molecular biology, human genetics, immunology, endocrinology, psychiatry and other relevant courses, such as Health Care Systems and Health Policy, and Physicians and Patients).

68 Id. (requiring a total of 10 units of pharmacology, 9 units of nervous system, and 5 units of psychiatry in the first two years of study).

69 UCSD, SCHOOL OF MEDICINE, CATALOG, 2002-03, CURRICULUM: THE NEVER ENDING DIALOGUE, available at http://medschool.ucsd.edu/Catalog/08.html (last visited Nov. 13, 2003) (indicating the Social and Behavioral Science course “looks at the patient as a person, with all that implies, but also as a unique ‘biopsychosocial matrix’ with a history and a future”).

70 See, e.g., STANFORD MD CURRICULUM, supra note 60, at http://www.med.stanford.edu/school/catalog/bookone/mdcurriculum.html.

71 The exam is called the United States Medical Licensing Examination (“USMLE”). Results of the USMLE “are reported to medical licensing authorities in the United States and its territories for use in granting the initial license to practice medicine” and are used to “assess a physician's ability to apply knowledge, concepts, and principles that are important in health and disease and that constitute the basis of safe and effective patient care.” USMLE-UNITED STATES MEDICAL LICENSING EXAMINATION, at http://www.usmle.org (last visited Nov. 13, 2003).

72 E.g., ARIZ. REV. STAT. ANN. § 32-1402 (West 2002); CAL. BUS. & PROF. CODE § 2001 (West 2003). For a list of state medical licensing boards and links to their webpages, see ADMINISTRATORS IN MEDICINE, at http://www.docboard.org (last visited Nov. 9, 2003).

73 See, e.g., MEDICAL BOARD OF CALIFORNIA, at http://www.medbd.ca.gov (last visited Nov. 9, 2003) (“The Medical Board of California is the State agency that licenses medical doctors, investigates complaints, disciplines those who violate the law, conducts physician evaluations, and facilitates rehabilitation where appropriate.”).

74 See, e.g., ARIZ. REV. STAT. ANN. § 32-1403 (West 2002); CAL BUS. & PROF. CODE § 2089; GA. CODE ANN. § 43-34-27 (2002).

75 See, e.g., CAL. BUS. & PROF. CODE § 2089.

76 See, e.g., id.

77 E.g., UCSD, DEPARTMENT OF PSYCHIATRY, RESIDENCY CURRICULUM, at http://psychiatry.ucsd.edu/residencyCurriculum.html (last visited Nov. 13, 2003).

78 “Residency education is the period of clinical education in a medical specialty that follows graduation from medical school, and prepares physicians for the independent practice of medicine.” ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION, at http://www.acgme.org (last visited Nov. 9, 2003) (giving definition under heading “About the ACGME”).

79 See, e.g., AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY, INC., GENERAL INFORMATION, WHAT IS AN APBN BOARD-CERTIFIED PSYCHIATRIST?, at http://207.229.182.32/geninfo/what_psychiatrist.html (last visited Nov. 9, 2003).

80 See CPA PSYCHOLOGIST PRESCRIBING, supra note 5, at http://www.calpsych.org/legislation/1999/claimvsfact.html (comparing psychologists’ four years of graduate school and one year of clinical training to psychiatrists’ four years of medical school and additional four years of residency training).

81 AAPA INFORMATION, supra note 4, at http://www.aapa.org/geninfo1.html.

82 AAPA, PHYSICIAN ASSISTANTS AS PRESCRIBERS OF CONTROLLED MEDICATIONS, at http://www.aapa.org/gandp/control.html (last revised June 2, 2003) [hereinafter AAPA PA PRESCRIBERS].

83 Id.

84 See id. (stating that with prior experience in health care field consequently comes prior training and/or clinical experience in pharmacology).

85 Id. (including biology, biochemistry, organic chemistry, physiology, microbiology and mathematics courses).

86 Id. (discussing the similarities between a physician assistant program and medical school).

87 See, e.g., UNIVERSITY OF WISCONSIN-MADISON, PHYSICIAN ASSISTANT PROGRAM, EMPLOYMENT GUIDE AND RESOURCES, available at http://www.medsch.wisc.edu/pa/employment/employment.html (last updated Feb. 2003).

88 AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS, PHYSICIAN ASSISTANT EDUCATIONAL PREPARATION FOR PRESCRIBING, at http://www.aapa.org/gandp/pharmpre.html (last revised July 16, 2003).

89 AAPA PA PRESCRIBERS, supra note 82.

90 See ASSOCIATION OF POSTGRADUATE PHYSICIAN ASSISTANT PROGRAMS, AAPAP PROGRAMS BY SPECIALTY, at http://www.appap.org/prog_specialty.html (last visited Nov. 12, 2003) (listing graduate specialties).

91 Compare supra note 87 and accompanying text, with sources cited supra note 12.

92 Compare SAN DIEGO STATE UNIVERSITY SCHOOL OF NURSING, at http://www.rohan.sdsu.edu/dept/chhs/nursing/index.html (last vistied Nov. 9, 2003) (listing course and grade requirements for its nursing school under “Preparation for Major & Sequence of Courses”), with STANFORD MD CURRICULUM, supra note 60, at http://www.med.stanford.edu/school/catalog/bookone/mdcurriculum.html, and SDSU CATALOG SPRING 2002, supra note 61, at http://www.sdsu.edu/cgi-bin/schedule/semester=spring02 (listing course and grade requirements of respective medical schools).

93 See, e.g., SAN DIEGO STATE UNIVERSITY SCHOOL OF NURSING, supra note 92, at http://www.rohan.sdsu.edu/dept/chhs/nursing/index.html (indicating care systems).

94 Id. (stating the SDSU nursing program requires “a minimum of 45 upper division units in nursing” and 10 units in natural science and 16 pre-requisite science courses, amounting to 1,065 hours of education based on the medical model). This time does not include labs and clinical internship hours. Compare SAN DIEGO STATE UNIVERSITY, GENERAL CATALOG 2001-02, at http://coursecat.sdsu.edu/0102/index.html (Apr. 16, 2001), with STANFORD MD CURRICULUM, supra note 60, at http://www.med.stanford.edu/school/catalog/bookone/mdcurriculum.html (listing the requirements for a medical degree).

95 Compare SAN DIEGO STATE UNIVERSITY SCHOOL OF NURSING, supra note 92, at http://www.rohan.sdsu.edu/dept/chhs/nursing/index.html, with APA Press Release, supra note 12, at http://www.apa.org/practice/nm_rxp.html (detailing course hour requirements).

96 See AMERICAN NURSES ASSOCIATION, STATES WHICH RECOGNIZE CLINICAL NURSE SPECIALIST IN ADVANCED PRACTICE, at http://www.nursingworld.org/gova/charts/cns.htm (last updated Feb. 1, 2000).

97 AMERICAN NURSES CREDENTIALING CENTER, FREQUENTLY ASKED QUESTIONS ABOUT ANCC CERTIFICATION, at http://www.nursingworld.org/ancc/certification/cert/certfaqs.html (last visited Nov. 9, 2003).

98 Id.

99 Id.

100 E.g., ARK. CODE ANN. § 17-87-310 (Michie 1987); COLO. REV. STAT. ANN. § 12-38-111.6 (West 2002); HAW. REV. STAT. ANN. § 457-8.6 (Michie 2002); IND. CODE ANN. § 25-23-1-19.5 (West 2001); KEN. REV. STAT. ANN. § 314.042 (Michie 2001); N.M. STAT. ANN. § 61-3-23.2 (Michie 2002); VA. CODE ANN. § 54.1-2957.01 (Michie 2002); W. VA. CODE ANN. § 30-7-15a (Michie 2002). See ANA, 2000 PRESCRIPTIVE AUTHORITY CHART, at http://www.nursingworld.org/gova/charts/dea.htm (revised Feb. 1, 2000) (displaying the type of nurse practitioner, permitted drug schedule, and whether a practice agreement, collaboration, or required protocol to prescribe exists for each state) [hereinafter ANA CHART].

101 See, e.g., 21 U.S.C.A. § 812(b) (1999) (giving criteria for controlled drugs Schedules I-V, Schedules I and II having high abuse potential); ARK CODE ANN. § 17-87-310 (Michie 2002) (limiting the prescriptive authority of nurses to Schedules III-V drugs); COLO. REV. STAT. ANN. § 12-36-106.3 (West 2002) (requiring a collaborative agreement with a physician); CONN. GEN. STAT. § 20-87a (West 1999) (requiring a special procedure for a nurse to prescribe drugs from Schedules II and III); ILL. COMP. STAT. § 65/15-20 (West 1993) (requiring a mid-level practitioner controlled substance license to prescribe drugs from Schedules III-V); IND. CODE ANN. § 25-23-1-19.4 (West 2001) (requiring a collaborative agreement); KEN. REV. STAT. ANN. § 314.042 (Michie 2001) (requiring a collaborative agreement); ANA CHART, supra note 100, at http://www.nursingworld.org/gova/charts/dea.htm.

102 See ANA CHART, supra note 100, at http://www.nursingworld.org/gova/charts/dea.htm; AMERICAN ACADEMY OF NURSE PRACTITIONERS, DATA AND SURVEY INFORMATION, at http://www.aanp.org/Practice+Policy+and+Legislation/Regulation/DEARegulation/DEA.asp (last visited Nov. 10, 2003) (linking to Nurse Practitioner Prescriptive Authority) [hereinafter AANP DATA].

103 See ANA CHART, supra note 100, at http://www.nursingworld.org/gova/charts/dea.htm.

104 See GA. CODE ANN. § 16-13-72 (2003); ANA CHART, supra note 100, at http://www.nursingworld.org/gova/charts.dea.htm; AANP DATA, supra note 102, at http://www.aanp.org/Practice+Policy+and+Legislation/Regulation/DEARegulation/DEA.asp.

105 ARIZ. ADMIN. CODE R4-19-507 (2003); ARIZONA NURSE PRACTITIONER CONNECTION, ARIZONA NURSE PRACTITIONER SCOPE OF PRACTICE, at http://aznpconnection.netfirms.com/azscope.htm (last visited Nov. 12, 2003) (stating that a nurse practitioner has a generalized ethical and moral duty to discuss a patient's care with a qualified practitioner if there is any doubt about what care is optimal, but is no longer legally required to supply the name of the consulted practitioner).

106 See supra note 96 and accompanying text.

107 See sources cited supra note 100.

108 “Medical science courses” refers to college biology, college general and organic chemistry, calculus, physics, physiology, anatomy, microbiology, biochemistry, and all advanced courses within these areas of study. See supra notes 62-63, 68-70, 85-87, 92-94 and accompanying text. In comparison, behavioral science courses focus on the identification, cause, and treatment of behavioral disorders, not requiring completion of medical science courses. See infra notes 259-60 and accompanying text.

109 See supra Parts II.A.-C.

110 Id.

111 Id.

112 See infra Part III.

113 See, e.g., UNIVERSITY OF ARIZONA, 2002-03 GENERAL CATALOG, BACHELOR OF ARTS – PSYCHOLOGY, available at http://www.arizona.edu/academic/oncourse/data/024/A8zPSYCzBAxzxxx.html (last updated Oct. 30, 2003) [hereinafter ARIZONA 2002-03 CATALOG, BAPSYCHOLOGY]; CALIFORNIA STATE UNIVERSITY, FRESNO, 2003-04 GENERAL CATALOG, DEPARTMENT OF PSYCHOLOGY, available at http://www-catalog.admin.csufresno.edu/current/pdf/psych.pdf (last visited Nov. 12, 2003) [hereinafter CSU, FRESNO CATALOG-PSYCHOLOGY].

114 See, e.g., CSU, FRESNO CATALOG-PSYCHOLOGY, supra note 113, at http://wwwcatalog.admin.csufresno.edu/current/pdf/psych.pdf (stating that…education requirement); CALIFORNIA STATE UNIVERSITY, FRESNO, 2003-04 GENERAL CATALOG, GENERAL EDUCATION, at http://wwwcatalog.admin.csufresno.edu/current/gened.html (last visited Nov. 12, 2003) (indicating general quantitative reasoning) [hereinafter CSU, FRESNO CATALOG-GENERAL].

115 Id. (showing that CSU, Fresno, like the majority of universities, considers psychology to be a behavioral science, and does not accept psychology courses in satisfaction of natural and physical science course requirements).

116 See infra Part III. (discussing the increased difficulty of science courses taken by science majors (e.g., biology, chemistry) compared to non-major science courses). Physicians and physician assistants most often take the same science courses as science majors. Nursing students, however, may fulfill their organic chemistry and a few of their biology prerequisites with organic chemistry and biology courses falling outside the science major requirements.

117 See, e.g., CSU, FRESNO CATALOG-GENERAL, supra note 114, at http://wwwcatalog.admin.csufresno.edu/current/gened.html (explaining that a student may complete undergraduate science requirements with only 12 units of science courses, including one upper division science class).

118 See, e.g., ARIZONA 2002-03 CATALOG, BA-PSYCHOLOGY, supra note 113, at http://www.arizona.edu/academic/oncourse/data/024/A8zPSYCzBAxzxxx.html; CSU, FRESNO CATALOG-PSYCHOLOGY, supra note 113, at http://www-catalog.admin.csufresno.edu/current/pdf/psych.pdf.

119 See, e.g., ARIZONA 2002-03 CATALOG, BA-PSYCHOLOGY, supra note 113, at http://www.arizona.edu/academic/oncourse/data/024/A8zPSYCzBAxzxxx.html (explaining that the psychobiology and neuroscience requirements can be satisfied with non-medical related courses); UNIVERSITY OF ARIZONA, 2002-03 GENERAL CATALOG, FALL 2002 COURSE DESCRIPTIONS, at http://catalog.arizona.edu/2002-03/courses/024/PSYC.html (last updated Feb. 13, 2003).

120 See supra Parts II.A.-C., explaining medical, physician assistant, and nursing student programs all require a uniformed set of pre-requisite and co-requisite science courses for graduation.

121 See, e.g., UNIVERSITY OF WISCONSIN-MADISON, DEPARTMENT OF PSYCHOLOGY, FREQUENTLY ASKED QUESTIONS, at http://psych.wisc.edu/ugstudies/topten.html (last updated Apr. 3, 2003); UNIVERSITY OF WISCONSIN-MADISON, DEPARTMENT OF PSYCHOLOGY, REQUIREMENTS FOR THE MAJOR, at http://psych.wisc.edu/ugstudies/requirementsPost2001.html (last updated Apr. 3, 2003).

122 Students earning BS degrees in psychology with a science minor at the University of Arizona, for example, complete 18-22 science units for the minor as well as additional science units required for the major, bringing the total to approximately 27 science units for completion of the BS degree. See UNIVERSITY OF ARIZONA, 2003-04 GENERAL CATALOG, BACHELOR OF SCIENCEPSYCHOLOGY, available at http://www.arizona.edu/academic/oncourse/data/034/A8zPSYCzBSxzxxx.html (last updated Nov. 5, 2003) (outlining the “supporting science requirement” of additional coursework in mathematics, biology and chemistry or physics); UNIVERSITY OF ARIZONA, 2003-04 GENERAL CATALOG, DEPARTMENT OF PSYCHOLOGY, available at htpp://www.catalog.arizona.edu/2003-04/dept/PSYC.shtml (last updated June 6, 2003) (stating that the BS in psychology is a “[s]cience-[i]ntensive major,” requiring both a science minor and additional coursework in mathematics, biology, and chemistry or physics); UNIVERSITY OF ARIZONA, 2003-04 GENERAL CATALOG, MINOR REQUIREMENT REPORTS, available at http://www.arizona.edu/academic/oncourse/data-minors/interface/ (last updated Oct. 8, 2003) (providing links stating that to complete the science minors requirement for a Bachelor of Science in Psychology students must complete 18-22 units).

123 CSU, FRESNO, 2001-02 GENERAL CATALOG, ACADEMIC REGULATIONS, available at http://www-catalog.admin.csufresno.edu/archives/0102/acadreg.html (last visited Nov. 10, 2003) (defining double-counting as“[a]llowing one course to fulfill two separate requirements concurrently; e.g., allowing one course to fulfill both a major requirement and the upper-division writing skills requirement, or allowing one course to fulfill both a major requirement and General Education requirement”).

124 Students may graduate with Bachelor of Science of Psychology degrees having taken few medically related science courses. See ARIZONA 2002-03 CATALOG, BA-PSYCHOLOGY, supra note 113, at http://www.arizona.edu/academic/oncourse/data/024/A8zPSYCzBAxzxxx.html.

125 See, e.g., id. (requiring only 3 units from psychobiology & neuroscience distribution).

126 See UNIVERSITY OF ARIZONA, 2002-03 GENERAL CATALOG, DEPARTMENT OF PSYCHOLOGY, available at http://catalog.arizona.edu/2002-03/dept/PSYC.shtml (last updated Mar. 12, 2002) (“BS students are required to select a minor in one of the following areas: Biochemistry, Computer Science, Ecology and Evolutionary Biology, Mathematics, Molecular and Cellular Biology, Physics, or the Pre-Health Professions minor.”) [hereinafter ARIZONA CATALOG-PSYCHOLOGY].

127 See supra Parts II.A.-C.

128 See, e.g., PETERSON's GRADUATE & PROFESSIONAL PROGRAMS: AN OVERVIEW (37th ed. 2003). See generally EDUCATIONAL TESTING SERVICE, GRADUATE RECORD EXAMINATION, FREQUENTLY ASKED QUESTIONS ABOUT THE NEW GENERAL TEST, at http://www.gre.org/faqnew.html (last updated July 15, 2003) (explaining the general format of the test, what it measures, how it is scored, and other information for potential test takers); ETS, GRE, COMPUTER BASED GENERAL TEST DESCRIPTION, at http://www.gre.org/cbttest.html#description (last updated June 23, 2003).

129 PETERSON's GRADUATE & PROFESSIONAL PROGRAMS: AN OVERVIEW, supra note 128.

130 E.g., CSU, FRESNO, GRADUATE PROGRAMS, DEPARTMENT OF PSYCHOLOGY, available at http://psych.csufresno.edu/psychweb/graduate (last visited Nov. 10, 2003) (link to Master of Arts degree requirements) [hereinafter CSU, FRESNO GRADUATE-PSYCHOLOGY].

131 Id. (link to M.S. degree requirements); UNIVERSITY OF ARIZONA, GRADUATE CATALOG 2003-04, REQUIREMENTS FOR MASTER's DEGREES, available at http://grad.admin.arizona.edu/catalog/masters/ (last visited Nov. 12, 2003) (stating that minimum of 30 units of graduate work, including thesis, is required for master of science degree).

132 CSU, FRESNO GRADUATE-PSYCHOLOGY, supra note 130, at http://psych.csufresno.edu/psychweb/graduate (linking to requisite courses in the programs).

133 Id.

134 ARIZONA 2002-03 CATALOG, BA-PSYCHOLOGY, supra note 113, at http://www.arizona.edu/academic/oncourse/data/024/A8zPSYCzBSxzxxx.html.

135 Compare UNIVERSITY OF ARIZONA, DEPARTMENT OF PSYCHOLOGY, CURRICULUM, CLINICAL PSYCHOLOGY PROGRAM, at http://psych.arizona.edu/clinical/curriculum.html (last visited Nov. 10, 2003) (listing the required courses for a degree in clinical psychology), with COLUMBIA UNIVERSITY, HEALTH SCIENCES CURRICULUM ONLINE, at http://www.columbia.edu/itc/hs/medical/histology/course_online/index.html (last visited Nov. 10, 2003) (listing the required courses for a medical doctorate), and COLUMBIA UNIVERSITY SCHOOL OF NURSING, ENTRY TO PRACTICE PRORGAM FOR NON-NURSE COLLEGE GRADUATES, at http://www.healthsciences.columbia.edu/dept/nursing/academics-programs/etp.html (last visited last update July 2003) (listing the required course for a nursing degree), and EASTERN VIRGINIA MEDICAL SCHOOL, at http://www.evms.edu/hlthprof/mpa/curriculum.html (last revised Apr. 15, 2003) (listing the required courses necessary for obtaining Master of Physician Assistant degree).

136 See, e.g., UNIVERSITY OF ARIZONA, GRADUATE PROGRAMS, CLINICAL PSYCHOLOGY, at http://www.psychology.arizona.edu/programs/g_each/clinical.php?option=2 (last updated Oct. 20, 2003).

137 E.g., ALLIANT INTERNATIONAL UNIVERSITY, CALIFORNIA SCHOOL OF PROFESSIONAL PSYCHOLOGY, at http://www.alliant.edu/cspp/psydclin.htm (last modified June 13, 2003).

138 Id.; ARIZONA CATALOG-PSYCHOLOGY, supra note 126, at http://catalog.arizona.edu/2002-03/dept/PSYC.shtml.

139 Psychiatrists oppose granting psychologists prescriptive authority because the emphasis of training in psychology is on a behavioral model that severely lacks adequate educational and experiential training in non-mental health issues. Ultimately, psychologists lack any understanding of non-mental health illnesses. Whether they can prescribe psychotropic medication safely is irrelevant. See, e.g., CPA PSYCHOLOGIST PRESCRIBING, supra note 5, at http://www.calpsych.org/legislation/1999/claimvsfact.html (arguing that psychiatrists and physicians are trained to treat biological illness and chemical imbalances as opposed to psychologists who are trained to treat human behavior).

N.M. STAT. ANN.§ 61-9-3(D) (repealed effective July 1, 2004) (defining the “practice of psychology” as “the observation, description, evaluation, interpretation and modification of human behavior by the application of psychological principles, methods and procedures for the purpose of preventing or eliminating symptomatic, maladaptive or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health and mental health … includ[ing] psychological testing or neuropsychological testing and the evaluation or assessment of personal characteristics[,] … counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, behavior analysis and therapy; diagnosis and treatment of any mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct and the psychological aspects of physical illness, accident, injury and disability; and psychoeducational evaluation, therapy, remediation and consultation”). Compare N.M. STAT. ANN. § 61-3-3 (repealed effective July 1, 2004), with N.M. STAT. ANN. § 61-3-3(K) (Michie 1978) (defining “professional registered nursing” as “requiring substantial knowledge of the biological, physical, social and behavioral sciences and nursing theory…[including] establishing a nursing diagnosis … [and] collaborating with other health care professionals in the management of health care”), and N.M. STAT. ANN. § 61-3-3(L) (Michie 1978). See also supra Part II.B.

140 See supra Part II.

141 E.g., CAL. BUS. & PROF. CODE § 2903 (West 2003).

142 E.g., id. § 2961.

143 See, e.g., id. § 101.6 (describing as one purpose of the board to “register or otherwise certify persons in order to identify practitioners and ensure performance according to set and accepted professional standards”).

144 See, e.g., CALIFORNIA BOARD OF PSYCHOLOGY, MANDATORY CONTINUING EDUCATION REQUIREMENTS, at http://www.psychboard.ca.gov/licensing/education.html (last visited Nov. 10, 2003) (requiring 36 hours of continuing education between licensing periods).

145 APNA PRESCRIPTIVE AUTHORITY, supra note 4, at http://www.apna.org/papers/positionpapers.html (“In increasing numbers, states are legislating prescriptive practice authority for advanced practice nurses … to increase access to health care and to utilize nurses to their full capacity as accessible, cost effective, full service providers.”); AAPA INFORMATION, supra note 4, at http://www.aapa.org/geninfo1.html (stating that the purpose in creating physician assistant position was to supplement the need for primary care physicians).

146 See APA Press Release, supra note 12, at http://www.apa.org/practice/nm_rxp.html.

147 Id.

148 James A. Ciarlo, et al., Focusing on “Frontier”: Isolated Rural America, Letter to the Field No. 2, at http://www.wiche.edu/MentalHealth/Frontier/letter2.html (last revised Apr. 11, 1996).

149 Id. (defining and classifying rural areas).

150 FEDERAL OFFICE OF RURAL HEALTH POLICY, FACTS ABOUT … RURAL PHYSICIANS, at http://www.shepscenter.unc.edu/research_programs/rural_program/phy.html (last visited Nov. 10, 2003).

151 Id.

152 Id.

153 See Holzer et al., supra note 13, at http://www.wiche.edu/MentalHealth/Frontier/letter11.html; Geller & Muus, supra note 20, at http://www.wiche.edu/MentalHealth/Frontier/letter5.html; Mohatt, supra note 13, at http://www.wiche.edu/MentalHealth/Frontier/letter4.html.

154 Holzer et al., supra note 13, at http://www.wiche.edu/MentalHealth/Frontier/letter11.html (referring to chart at figure 1).

155 See Richard Sherer, Mental Health Care Shortages Will Need Creative Solutions, PSYCHIATRIC TIMES (Sept. 2001) (on file with author) (“A given community is designated as underserved when it has ‘(a) a population-to-core mental health professional ratio greater than or equal to 6,000:1 and a population-to-psychiatrist ratio greater than or equal to 20,000:1, or (b) a population-to-core-professional ratio greater than or equal to 9,000:1, or (c) a population-topsychiatrist ratio greater than or equal to 30,000:1,’ according to BPHC [Bureau of Primary Health Care] guidelines.”).

156 Mohatt, supra note 13, at http://www.wiche.edu/MentalHealth/Frontier/letter11.html.

157 See Holzer et al., supra note 13, at http://www.wiche.edu/MentalHealth/Frontier/letter11.html; Geller & Muus, supra note 20, at http://www.wiche.edu/MentalHealth/Frontier/letter5.html.

158 See id. (citing Regier, Darrel A. et al., The De Facto US Mental Health Services System: A Public Health Perspective, 35 ARCHIVES GEN. PSYCHIATRY 685, 688 (1978)CrossRefGoogle Scholar).

159 Holzer et al., supra note 13, at http://www.wiche.edu/MentalHealth/Frontier/letter11.html.

160 Id.

161 Id.

162 Id.

163 Id.

164 Id.

165 Id.

166 Id.

167 Id.

168 Id.

169 Id. (defining psychologist as “M.A. or greater psychologists working in health-related settings by population per square mile”). These percentages obviously decrease by removing masterslevel psychologists from consideration for prescriptive authority.

170 See id.

171 Id.

172 Id.

173 See Editorial, Ignoring Mental Illness in Kids, CHI. TRIB., July 23, 2001, available at 2001 WL 4096611; Culture Counts in Mental Health Services and Research Finds New Surgeon General Report, U.S. NEWSWIRE, Aug. 26, 2001, available at 2001 WL 21897399; Allison Sherry, Mentally Ill Swamp ER Staffs: Some Fear Treatment of Other Cases Impaired, DENV. POST, Aug. 27, 2001, available at 2001 WL 6760857; NATIONAL HEALTH CARE FOR THE HOMELESS COUNCIL, BASICS OF HOMELESSNESS, at http://www.nhchc.org/Publications/basics_of_homelessness.htm (last updated Apr. 7, 2003) [hereinafter NHCHC].

174 See NHCHC, supra note 173, at http://www.nhchc.org/Publications/basics_of_homelessness.htm.

175 Holzer et al., supra note 13, at http://www.wiche.edu/MentalHealth/Frontier/letter11.html.

176 Id.

177 Id.

178 See supra notes 173-74 and accompanying text.

179 See Ronald E. Fox, & Morgan T. Sammons, A History of Prescription Privileges, 29 APA MONITOR ONLINE (Sept. 1998), available at http://www.apa.org/monitor/sep98/prescrip.html.

180 Id.

181 See Ronald F. Levant, We Have Come a Long Way: The Prescriptive Authority Initiative, 32 MONITOR ON PSYCHOL. (Nov. 2001), available at http://www.apa.org/monitor/nov01/sp.html.

182 See ASAP, at http://www.apa.org/divisions/div55/ (last visited Nov. 10, 2003).

183 E.g., H.B. 139, 1999 Leg., 21st Sess. (Ala. 1999); S.B. 777, 1995-96 Reg. Sess. (Cal. 1995); S.B. 2050, 1997-98 Reg. Sess. (Cal. 1997); S.B. 202, 145th Gen. Assemb., 1999-00 Reg. Sess. (Ga. 1999); H.B. 353, 1999 Gen. Assemb., 1999-00 Reg. Sess. (Ga. 1999); H.B. 1311, 1997 19th Leg. (Haw. 1997); S.B. 1402, 1999 91st Gen. Assem., 1999-00 Reg. Sess. (Ill. 2000); H.B. 1736, 1999 91st Gen. Assemb. (Ill. 1999); S.B. 677, 1999 Reg. Sess. (La. 1999); H.B. 1286, 1999 Reg. Sess. (La. 1999).

184 “[L]egislation has been introduced in nine states: AK, CA, FL, IL, GA, HI, LA, MO and MT (although the MT bill was not supported). Of these, Louisiana has made the most progress.” Carol Williams-Nickelson, Prescription Privileges Fact Sheet: What Students Should Know About the APA's Pursuit of Prescription Privileges for Psychologists (RxP), at http://www.apa.org/apags/profdev/prespriv.html (last visited Nov. 10, 2003).

185 N.M. STAT. ANN. § 61-9-17 (repealed effective July 1, 2010).

186 See Julien, supra note 15; AMERICAN PSYCHIATRIC ASSOCIATION, STATE OF THE STATES: PSYCHOLOGISTS’ PRESCRIBING PRIVILEGES, at http:www.psych.org/pub_pol_adv/statecostex.cfm (March 2003) (discussing assistance of grassroots advocacy efforts to oppose prescriptive authority for psychologists); ASAP, ASAP READER #125, at http://www.apa.org/divisions/div55/ASAPReader125.htm (Mar. 27, 2002) (listing the Committee Against Medicalizing Psychology as one of the organizations opposing prescriptive authority for psychologists in New Mexico).

187 See discussion supra Part III.

188 See Letter from E. Mario Marquez, supra note 48, at http://www.apa.org/divisions/div55/RxPResources.htm.

189 See supra Part II.A.

190 See supra Part III.

191 See generally discussion supra Part III.

192 See, e.g., Julien, supra note 15 (quoting president of the Connecticut Psychological Association, arguing that because of the close psychologist-patient relationship, psychologists are “in an ideal position to make judgments about these medications—and to monitor it”).

193 See Geller, supra note 20, at http://www.wiche.edu/MentalHealth/Frontier/letter10.html (“At that time [1978], … approximately 60 percent of the total persons affected by mental disorders sought treatment in a primary care setting. Subsequent studies have continued to affirm the presence and importance of this… .”).

194 See id.; sources cited supra note 3.

195 See STANFORD MD CURRICULUM, supra note 60, at http://www.med.stanford.edu/school/catalog/bookone/mdcurriculum.html.

196 See Broadhead, W. Eugene et al., Tricyclic Antidepressant Prescribing Nonpsychiatric Disorders: An Analysis Based on Data from the 1985 National Ambulatory Medical Care Survey, 33 J. FAM. PRAC. 24 (1991)Google ScholarPubMed; Feldman, Arnold, The Family Practitioner As Psychiatrist, 135 AM. J. PSYCHIATRY 728 (1978)Google ScholarPubMed; Jones, L. Ralph et al., Mental Health Training of Primary Care Physicians: An Outcome Study, 18 INT’L J. PSYCHIATRY MED. 107, 119 (1988)Google Scholar; Pincus, Harold A. et al., Models of Mental Health Training in Primary Care, 249 JAMA 3065, 3065, 3067-68 (1983)CrossRefGoogle ScholarPubMed; Zimmerman, Marc A. & Wienckowski, Louis A., Revisiting Health And Mental Health Linkages: A Policy Whose Time Has Come … Again, 12 J. PUB. HEALTH POL. 510, 519 (1991)CrossRefGoogle Scholar.

197 Anderson, Susan M. & Harthorn, Barbara Herr, The Recognition, Diagnosis, and Treatment of Mental Disorders by Primary Care Physicians, 27 MEDICAL CARE 869, 881-82 (1989)CrossRefGoogle Scholar.

198 Id. at 882.

199 Geller, supra note 20, at http://www.wiche.edu/MentalHealth/Frontier/letter10.html.

200 See supra text accompanying note 198.

201 See supra Part III. This is the crucial fact distinguishing psychologists from other prescribing healthcare providers (physician assistants and nurse practitioners) discussed in this Article.

202 ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf.

203 Id.

204 APA Press Release, supra note 12, at http://www.apa.org/practice/nm_rxp.html (emphasis added) (quoting Russ Newman, the Executive Director for Professional Practice, American Psychological Association). See also, Letter from E. Mario Marquez, supra note 48, at http://www.apa.org/divisions/div55/RxPResources.htm (asserting that the PDP “[p]roject proved that psychologists could be trained to safely and effectively prescribe psychotropics to their patients) (emphasis added)).

205 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf (stating that the PDP participants “performed with excellence wherever they were placed,” and that the graduates “filled different niches and brought unique perspectives to their various assignments”).

206 See infra text accompanying note 228.

207 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf.

208 Id. (representing a 23% attrition rate in Table 1).

209 Id.

210 Id. (referring to Table 2's didactic curriculum for the PDP groups for a breakdown of courses and hours).

211 Id. (comparing Group A's curriculum to Groups B, C, and D's coursework in Table 2).

212 Id. Groups B, C, and D “took a combination of four standard USUHS Medical School core courses, five modified and abbreviated Medical School courses taught by Medical School faculty, and two Graduate School of Nursing (GSN) courses …, includ[ing] interviewing, history taking, and physical examination. The total didactic instruction for the final class was approximately 700 hours, and curriculum differences from Group B-to-C-to-D were relatively minor.” Id.

213 Id. (stating that Group A's practicum was closely linked with the psychiatry residency program).

214 Id. (discussing the Clinical Practicum Program).

215 Id. (prescribing 41 psychotropic medications for diagnoses including: substance abuse, non bi-polar disorder major depression, generalized anxiety, panic, obsessive-compulsive and post traumatic stress disorders, schizophrenia spectrum, dysthymia, anorexia/bulimia, and somatiform disorder).

216 Id. (describing Group B's rotations in psychiatry clinic and consultation/liaison services, Groups C and D's rotations including psychiatry and psychology clinics, emergency room call training, biological psychiatry seminars, and case conferences).

217 Id. (referring to Table 1).

218 Id. (describing the practice profiles of the graduates).

219 Id.

220 Id. (“All graduates were initially proctored by psychiatrists. Half of them had advanced to independent provider status with its standard minimum review of 10% of medication cases.”).

221 Id. (“The PDP was not designed to replace psychiatrists or produce mini-psychiatrists or psychiatrist extenders, and it did not do so. Instead, the program ‘products’ were extended psychologists with a value-added component prescriptive authority provides. They continued to function very much in the traditions of clinical psychology (psychometric tests, psychological therapies) but a body of knowledge and experience was added that extended their range of competence.”).

222 Id. (“On posts where there was a shortage of psychiatrists, the graduates tended to work side-by-side with psychiatrists, performing many of the same functions a ‘junior psychiatrist’ might perform… . “They [the psychologists] essentially mirrored what psychiatrists did with the same population, and, in fact, they differed little from the private practices of the psychiatrists on the Evaluation Panel.”).

223 Id.

224 Id.

225 Id. “Two of these chiefs completed their PDP training less than a year earlier. Other indicators of quality and achievement that characterized this cohort were present when they entered the program. They all had not only a doctorate in clinical psychology but also clinical experience that ranged from a few to more than 10 years. All but two had military experience.” Id.

226 Id. “They generally had minimal education in the traditional premedical courses.” Id. Unfortunately, with such a small sample size, only a few science courses for one or two participants could make a significant difference in outcome reports.

227 Id. See supra text accompanying note 210 (indicating that despite the a limited background in pre-medical courses, two of the ten participants (20%) completed an additional 700 hours of medical school science courses compared to the other participants. Thus, the Group A psychologists overcame any deficit in their science backgrounds).

228 Id.

229 Id.

230 Id. (stating that the curriculum was adapted to the proposed role of a prescribing psychologist after evaluating Group A's performance).

231 Id.

232 Id. (listing other professionals who would benefit from training (psychiatric nurses who hold a masters of science in nursing, M.D. practitioners who have little clinical experience in psychiatric treatment, and those holding doctorates in clinical pharmacy)).

233 Clay, Rebecca A., State Leaders Convene in Washington, D.C.: Meeting Emphasizes Organizational and Advocacy Issues, 29 APA MONITOR No. 4 (Apr. 1998)Google Scholar, available at http://www.apa.org/monitor/apr98/state.html (indicating there were 70,000 licensed psychologists in 1995).

234 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf (referring to Table 2)

235 Id.. (“[E]ight out of ten [of the graduates] were serving as chiefs or assistant chiefs of an outpatient psychology clinic or a mental health clinic.”).

236 Id.

237 See supra text accompanying note 11; Letter from E. Mario Marquez, supra note 48, at http://www.apa.org/divisions/div55/RxPResources.htm.

238 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf.

239 See Letter from E. Mario Marquez, supra note 48, at http://www.apa.org/divisions/div55/RxPResources.htm (citing facts about the lack of treatment of children as part of psychologists’ intention to treat this population).

240 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf.

241 Id. (discussing the need to shorten and tailor certain courses in the medical school didactic program to reflect the “specific needs of prescribing psychologists”).

242 Id. Contra ASAP, WEEKLY READER #105, at http://www.apa.org/divisions/div55/WR105.html (May 31, 2001) (responding to accusation that the new American Psychological Association's didactic standard recommendation of 300 didactic hours is inadequate).

243 ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf.

244 Letter from E. Mario Marquez, supra note 48, at http://www.apa.org/divisions/div55/RxPResources.htm (overstating the number of credit hours by 20% when claiming that “approximately 36 graduate semester credit hours” are required).

245 See N.M. STAT. ANN. § 61-9-17.1 (repealed effective July 1, 2010); APA Press Release, supra note 12, at http://www.apa.org/practice/nm_rxp.html.

246 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf; infra text accompanying notes 250-54. Compare APA Press Release, supra note 12, at http://www.apa.org/practice/nm_rxp.html, with text accompanying text supra notes 211, 229.

247 See supra text accompanying note 11; Letter from E. Mario Marquez, supra note 48, at http://www.apa.org/divisions/div55/RxPResources.htm.

248 See ASAP, WEEKLY READER #105, supra note 242, at http://www.apa.org/divisions/div55/WR105.html (explaining that the original Department of Defense program was not designed to train psychologists, but rather had to be modified many times); ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf.

249 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf.

250 Compare id. (requiring 712 didactic hours for the PDP), with Letter from E. Mario Marquez, supra note 48, at http://www.apa.org/divisions/div55/RxPResources.htm (requiring 450 didactic hours for New Mexico). The New Mexico requirement equals only 63% of the PDP didactic requirements.

251 See supra text accompanying note 229.

252 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf; ASAP, WEEKLY READER #125, supra note 186, at http://www.apa.org/divisions/div55/ASAPReader125.htm (alleging that the New Mexico clinical practicum translates into approximately one year and one-half of experience with new patients rather than merely four months). John Winston Bush's approximation of four months appear more realistic based on 400 hours equaling 20% of a normal 2,000-hour work year amounting to ten weeks (two and one-half months) of fulltime work. Although unrealistic for educational purposes, a psychologist could easily treat 100 patients in this time and receive permission to prescribe medications though totally unqualified to do so. Also, the PDP psychologists average about 13 patients per month, whereby they could see 100 patients in less than eight months. Id. Either scenario allows completion of training in less than the one year recommended by the PDP. See supra text accompanying note 230.

253 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6/no3.pdf.

254 See N.M. STAT. ANN. § 61-9 (repealed effective July 1, 2010); ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf.

255 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf.

256 See ASAP, ASAP READER #123, supra note 38, at http://www.apa.org/divisions/div55/WR123.htm (quoting from Brian Ramirez's survey results that 40% of practicing psychologists would seek additional training if given prescriptive authority). With only 40% indicating a desire to gain this privilege, there is no indication or guarantee of how many of these practitioners would be willing to work in rural areas, especially with the likely increase in debt from the additional education requirements.

257 See supra text accompanying notes 229, 242.

258 See ASAP, ASAP READER #124, at http://www.apa.org/divisions/div55/ASAPReader124.html (Mar. 11, 2002) (arguing that psychologists’ doctorates should be taken into account in determining the amount of medical education necessary to ensure that medications are prescribed safely). Contra, CPA PSYCHOLOGIST PRESCRIBING, supra note 5, at http://www.calpsych.org/legislation/1999claimvsfact.html (arguing that psychologists have an average of five years of full-time training including only one year of clinical work).

259 PHYSICIAN's WEEKLY, supra note 16, at http://www.physweekly.com/archive/01/07_02_01/pc.html (“Psychologists’ education deals with human behavior—not human biology and pathology. They can earn a PhD by taking a single course in the biological basis of behavior.”). See, e.g., ARIZONA 2002-03 CATALOG, BA-PSYCHOLOGY, supra note 113, at http://www.arizona.edu/academic/oncourse/data/024/A8zPSYCzBAxzxxx.html (requiring two natural science courses at a level below college biology, one nature science course like ecology or geology, one mathematics course like intermediate algebra and one psychobiology course). Thus, a student can graduate without taking one basic college science course (i.e. college level chemistry, biology, physics or calculus). UNIVERSITY OF ARIZONA, GRADUATE PROGRAMS, CLINICAL PSYCHOLOGY PROGRAMS, CURRICULUM INFORMATION OF THE CLINICAL PSYCHOLOGY PROGRAM, available at http://psychology.arizona.edu/programs/g_each/clinical.php?option=4 (last updated Oct. 20, 2003) (stating that although the doctorate in clinical psychology requires psychology-related science courses, students are not required to take any basic college health science courses).

260 CPA PSYCHOLOGIST PRESCRIBING, supra note 5, at http://www.calpsych.org/legislation/1999/claimvsfact.html (emphasis added).

261 N.M. STAT. ANN. § 61-9 (repealed effective July 1, 2010) (referring to the entire article called the “Professional Psychologist Act”). See APA Press Release, supra note 12, at http://www.apa.org/practice/nm_rxp.html.

262 Compare N.M. STAT. ANN. § 61-9-17.1(5)-(6) (repealed effective July 1, 2010) (indicating a total didactic and practicum education requirement of 930 hours for granting psychologists prescriptive authority), with CAL. BUS. & PROF. CODE §2089 (West 2003) (indicating a 4,000-hour class and practicum minimum education requirement for physician licensure). Psychologists get only 23.35% (930 versus 4,000 hours) of the training required of a licensed physician). The physicians’ time does not include prerequisite and residency education and experience. The psychologists’ time ignores any medical science background. See discussion supra Parts II. & III.

263 See ASAP, ASAP READER #124, supra note 258, at http://www.apa.org/divisions/div55/ASAPReader124.html.

264 Compare discussion supra Part II.B., and discussion supra Part II.C., with discussion supra Part III.

265 ASAP, WEEKLY READER #107, at http://www.apa.org/divisions/div55/WR107.html (June 28, 2001) (stating that psychologists are properly trained to distinguish between psychological and physiological illnesses when symptoms are present that do not fit within the psychological profile, but need medical consultation to diagnose or treat the illness).

266 LEARNING DISABILITIES ASSOCIATION OF ONTARIO, at http://www.ldao.on.ca/ldao_projects/pei/defsupp/e8.html (last visited Nov. 13, 2003) (“Comorbidity is described as a situation where two or more conditions that are diagnostically distinguishable from one another tend to occur together.”).

267 See ASAP, WEEKLY READER #105, supra note 242, at http://www.apa.org/divisions/div55/WR105.html (responding to criticism that the PDP recommended 712 hours of instruction while the APA recommended only 300 hours, citing the conclusion that the many hours of medically related training were unnecessary).

268 Id.

269 STANFORD MD CURRICULUM, supra note 60, at http://www.med.stanford.edu/school/catalog/bookone/mdcurriculum.html.

270 See supra Parts II.B.-C.

271 See supra note 258 and accompanying text.

272 Associated Press, Prescription Drug Costs Surge—Again, at http://www.cnn.com/2002/HEALTH/03/29/prescription.spending.ap/ (Mar. 29, 2002) (stating there are 9,482 drugs on the retail market).

273 See ASAP, WEEKLY READER #105, supra note 242, at http://www.apa.org/divisions.div55/WR105.html (“[T]he goal of this intense APA program focuses on the FDA approved psychoactive medications, which currently numbers about 80 drugs, rather than the thousand or more drugs currently used in general medicine today.”). See Preston, Quick Reference to Psychotropic Medication, supra note 41, at http://www.apa.org/divisions/div55/PrestonMedicationCare2003.pdf, for a list of the current psychotropic medications commonly used.

274 See, e.g., ASAP, WEEKLY READER #107, supra note 265, at http://www.apa.org/divisions/div55/WR107.html.

275 See HEALTH RESOURCES AND SERVICES ADMINISTRATION, BUREAU OF PRIMARY HEALTH CARE, MENTAL HEALTH IN PRIMARY CARE, at http://www.bphc.hrsa.gov/bphc/mental/Default.htm (last visited Nov. 13, 2003) (“Numerous studies demonstrate excess mortality, morbidity, and health care use for those with mental health and substance abuse disorders… . The relationships between mental health and physical health are complex, and the excess morbidity and mortality cannot be completely explained by behavioral factors. There are several examples of a [sic] physical health issues that demonstrate this complexity. Depression has been the most widely examined of these relationships.”).

276 See Preston, supra note 41, at http://www.apa.org/divisions/div55/PrestonMedicationCare2003.pdf.

277 ASAP, WEEKLY READER #107, supra note 265, at http://www.apa.org/divisions/div55/WR107.html.

278 Id.

279 See APA Press Release, supra note 12, at http://www.apa.org/practice/nm_rxp.html.

280 Rebecca Kayo et al., Advancing the Profession: A Prescription for Success, available at http://www.apa.org/apags/profdev/advancingprof.html (last visited Nov. 13, 2003).

281 Sherer, supra note 155 (“States with the lowest ratios of psychiatrists-to-population also have low ratios of psychologists-to-population. Mississippi has only 11.3 psychologists per 100,000 population, roughly one-third of the national ratio.”).

282 Id.

283 See supra Part IV.

284 Id.

285 See Johnson, Norine G., Psychology Builds a Healthy World: Bringing It All Together, 2 ASAP TABLET 1, 1-2 (Feb. 20, 2001)Google Scholar, available at http://www.apa.org/divisions/div55/Tablet%2010/01/index.html; ASAP, WEEKLY READER #115, supra note 14, at http://www.apa.org/divisions/div55/WR115.html.

286 See Holzer et al., supra note 13, at http://www.wiche.edu/mentalhealth/frontier/letter11.html.

287 See id.

288 Id.

289 Id. See infra Part V.F.

290 APA, PRACTICE DIRECTORATE OFFICE OF RURAL HEALTH, APA RURAL HEALTH INITIATIVE: 1999 YEAR IN REVIEW, at http://www.apa.org/rural/report99.html (last visited Nov. 13, 2003) (“The Center for Mental Health Services reports that 55% of U.S. counties are not served by a psychologist, psychiatrist, or social worker and all of the counties are rural/frontier.”).

291 DEPARTMENT OF HEALTH AND HUMAN SERVICES, supra note 1, at http://www.surgeongeneral.gov/library/mentalhealth/pdfs/C2.pdf.

292 See Holzer et al., supra note 13, at http://www.wiche.edu/MentalHealth/Frontier/index.htm.

293 See Harding et al., supra note 35, at http://www.wiche.edu/MentalHealth/Frontier/letter11.html.

294 Id.

295 See, e.g., UNIVERSITY OF MINNESOTA, SCHOOL OF MEDICINE DULUTH, CENTER FOR RURAL MENTAL HEALTH STUDIES, at http://penguin.d.umn.edu/Departments/Rural_Mental_Health/home.htm (last modified Oct. 30, 2000) (“Financial barriers exist due to inadequacies in health insurance coverage and large numbers of rural residents with incomes below the poverty level.”).

296 See CME INC., RESOURCES, MENTAL HEALTH INFORMATION AND STATISTICS, at http://www.mhsource.com/resource/mh.html (last visited Nov. 13, 2003) (referring to the high costs of mental health treatment, its effects on society, and the importance of health insurance); Ignoring Mental Illness in Kids, supra note 173 (discussing cost impediments to child mental healthcare); NHCHC, supra note 173, at http://www.nhchc.org/Publications/basics_of_homelessness.htm (discussing costs associated with mental health treatment for the homeless).

297 See Bill Granting Psychologists Prescription Authority Moves Forward, supra note 13; Wiggins, supra note 37, at http://www.apa.org/divisions/div55/AHCCCS.htm.

298 AGENCY FOR HEALTHCARE RESEARCH AND QUALITY, HEALTH CARE COSTS AND FINANCING, at http://www.ahrq.gov/research/jan98/ra2.htm#head3 (last visited Nov. 13, 2003).

299 See sources cited supra note 296.

300 See supra Part IV.A.

301 See sources cited supra note 296.

302 See Wiggins, supra note 37, at http://www.apa.org/divisions/div55/AHCCCS.htm.

303 Id.

304 Id. (“Savings in salaries of psychologists compared to those of psychiatrists are estimated at $0.7 Million” annually, in regard to eliminating the need for a psychiatry consultation.).

305 Id.

306 Id.

307 Id. (referring to Appendix 1).

308 Id.

309 ASAP, ASAP READER #123, supra note 38, at http://www.apa.org/divisions/div55/WR123.html (quoting Brian Ramirez's survey results).

310 Id. (referring to comments by Dr. Wiggins).

311 Id.

312 Id.

313 See id. (noting that 85% of the psychologists surveyed agreed that malpractice rates would increase as a result of obtaining prescriptive authority); ASAP, WEEKLY READER #115, supra note 14, at http://www.apa.org/divisions/div55/WR115.html (“There is a shortage of mental health specialists who can prescribe.”).

314 ASAP, WEEKLY READER #109, at http://www.apa.org/divisions/div55/WR109.html (July 18, 2002).

315 Id.

316 Id. (“Regardless of a theoretical prediction of lowered rates of liability premiums for psychologists who prescribe, the professional liability premiums of psychologists will be determined by the experience of the insurance market place.”).

317 See Wiggins, supra note 37, at http://www.apa.org/divisions/div55/AHCCCS.htm (hypothesizing savings by the State of Arizona if psychologists were given prescriptive authority without addressing aspects of higher fees and insurance premiums).

318 See ASAP, WEEKLY READER #118, at http://www.apa.org/divisions/div55/WR118.html (Nov. 21, 2001) (“Mental health care is now a turf issue based on an entrenched mental health system dominated by medical values of care with medical doctors doing what they know best.”).

319 See Olfson, Mark et al., National Trends in the Outpatient Treatment of Depression, 287 JAMA 203, 206 (2002)CrossRefGoogle ScholarPubMed (indicating an increased acceptance of the use of medication for the treatment of mental disorders).

320 ASAP, ASAP READER #124, supra note 258, at http://www.apa.org/divisons/div55/ASAPReader124.html (“The future of psychiatry was held in the balance. The expansion of the scope of practice of psychological treatments for mental conditions was at its threshold.”).

321 ASAP, ASAP READER #123, supra note 38, at http://www.apa.org/divisions/div55/WR123.html.

322 Theresa Prescott, Patients Lose If Psychologists Prescribe, 36 PSYCHIATRIC NEWS 24 (Aug. 3, 2001), available at http://pn.psychiatryonline.org/cgi/content/full/36/15/24.

323 See ASAP, ASAP READER #123, supra note 38, at http://www.apa.org/divisions/div55/WR123.html.

324 See Williams-Nickelson, supra note 184, at http://www.apa.org/apags/profdev/prespriv.html.

325 See ASAP, WEEKLY READER #90, at http://www.apa.org/divisions/div55/WR90.html (Sept. 4, 2000).

326 See Jack M. Geller et al., Frontier Mental Health Strategies: Integrating, Reaching Out, Building Up, and Connecting, Letter to the Field No. 6, at http://www.wiche.edu/MentalHealth/Frontier/letter6.html (last visited Nov. 13, 2003) (emphasis added).

327 See Ali Hashmi, Commentary: The Prescription Jihad, 18 PSYCHIATRIC TIMES (July 2001), available at http://www.psychiatrictimes.com/p010720.html.

328 See Geller & Muus, supra note 20, at http://www.wiche.edu/MentalHealth/Frontier/letter5.html (“Some rural residents will not seek or utilize mental health care because of a lack of anonymity in treatment, the stigma associated with treatment, and clashes between treatment and traditional rural values such as independence and privacy.” (citation omitted)).

329 Geller et al., supra note 326, at http://www.wiche.edu/MentalHealth/Frontier/letter6.html.

330 Id.

331 Id. Telemedicine is the “practice of healthcare delivery, diagnosis, consultation, treatment and transfer of medical data and education using telecommunications.” Id.

332 See Sherer, supra 155.

333 See supra Part IV.A.

334 ASAP, WEEKLY READER #90, supra note 325, at http://www.apa.org/divisions/div55/WR90.html (“There is a clear understanding that we are attempting to get RxP legislation introduced in as many states as possible, as soon as possible… . This is no secret and is consistent with APA policy, APA Council actions, CAPP, PEPTO and why Division 55 has the acronym ASAP. This message needs to get out to the membership as a non-debatable item.”).

335 Id.

336 See, e.g., UNIVERSITY OF ARIZONA 2003-04 GENERAL CATALOG, FALL 2003 COURSE DESCRIPTIONS, available at http://catalog.arizona.edu/2003-04/courses/034/PSYC.html#GRAD (last updated Aug. 7, 2003).

337 See ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6/no3/pdf; supra Part V.B.

338 See N.M. STAT. ANN. § 61-9 (repealed effective July 1, 2010); APA Press Release, supra note 12, at http://www.apa.org/practice/nm_rxp.html.

339 Seldom are organizations permitted to experiment on the society as a whole to test a hypothesis (such as whether psychologists can prescribe safely in rural America) independently without significant safeguards and preparation.

340 See APA Press Release, supra, note 12. Compare ACNP DOD, supra note 11, at htt://www.acnp.org/pdffiles/vol6no3.pdf, with supra text acoompanying notes 229-30.

341 N.M. STAT. ANN. § 61-9-17 (repealed effective July 1, 2010). See APA Press Release, supra, note 12, at http://www.apa.org/practice/nm_rxp.html.

342 See supra text accompanying note 228.

343 See, e.g., APA, ETHICAL PRINCIPLES OF PSYCHOLOGISTS AND CODE OF CONDUCT § 1.14, available at http://www.apa.org/ethics/code1992.html#1.14 (last visited Nov. 13, 2003) (“Psychologists take reasonable steps to avoid harming their patients or clients, research participants, students, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.”); APA, ETHICAL PRINCIPLES OF PSYCHOLOGISTS AND CODE OF CONDUCT § 6.06, available at http://www.apa.org/ethics/code1992.html#6.06 (last visited Nov. 13, 2003) (revised in 2002 with differences in language).

344 See supra Part IV.

345 See supra notes 157-58, 162 and accompanying text.

346 See supra Part V.F.

347 See ASPA, ASAP READER #124, supra note 258, at http://www.apa.org/divisons/div55/ASAPReader124.html (“The New Mexico psychologists to the end always took the high road and argued their case on its merits rather than trying to create political pressure under the guise of unsupported public safety issues,” implying the issues of drug interactions, drug overdose, drug sideeffects, and a concern for a lack of sufficient education are ‘unsupported public safety issues.’”).

348 But see ACNP DOD, supra note 11, at http://www.acnp.org/pdffiles/vol6no3.pdf (“Virtually all graduates of the PDP considered the “short-cut” programs proposed in various quarters to be ill-advised. Most, in fact, said they favored a 2-year program much like the PDP program conducted at Walter Reed Army Medical Center, but with somewhat more tailoring of the didactic training courses to the special needs, and skills of clinical psychologists. Most said an intensive fulltime year of clinical experience, particularly with inpatients, was indispensable.”).

349 See ASAP, WEEKLY READER #118, supra note 318, at http://www.apa.org/divisions/div55/WR118.html (“We may quibble over whether ideally we should have more of this and less of that in this APA psychologically-oriented postdoctoral psychopharmacology curriculum. We may wish to tweak the model to enhance training in other ways.”). From their recommendations “quibble” and “enhance” means to reduce the minimum recommendation of the PDP by more than 50%! See supra text accompanying notes 229-30.

350 See supra Part V.F. (recommending a collaborative approach along with other effective, safe alternatives to granting psychologists prescriptive authority).

351 ASAP, WEEKLY READER #118, supra note 318, at http://www.apa.org/divisions/div55/WR118.html.

352 See THE AMERICAN HERITAGE DICTIONARY OF THE ENGLISH LANGUAGE 1427 (4th ed. 2000) (defining iron pyrite as a “brass-colored mineral” also known as “fool's gold”).