New Legislative Move in Battle With Psychologists

Having lost a few battles over state laws allowing psychologists to prescribe drugs in some cases, organized psychiatry is trying a new tactic--this time at the national level--in order to define professional boundaries in scientifically appropriate ways. The Healthcare Truth and Transparency Act is a newly introduced bill that would prohibit nonphysicians, such as psychologists, from using deceptive or misleading advertising that could be construed to imply that the advertiser "is a medical doctor, doctor of osteopathic medicine, doctor of dental surgery, or doctor of dental medicine or has the same or equivalent education, skills, or training."

In the House, the bill (HR 5688) was referred to the House Energy and Commerce Committee. One of the 6 original sponsors of the bill, Rep Michael Bilirakis (R, Fla), is the third-ranking majority member of that committee. Normally, a bill introduced this late in a congressional session--this one was tossed in the hopper on June 27--would have little chance of passage this year, especially because there is no Senate companion bill as of this writing. However, Bilirakis' position on the committee may allow him to get a vote on the bill in committee, and even on the House floor, before the end of the session. That is a long shot, though, and it would still leave the Senate to act much more quickly than is its wont.

"I have spoken with Chairman [of Energy and Commerce] [Joe] Barton and will be working with him and my colleagues during the next few weeks to ensure that this legislation receives all due consideration," Rep John Sullivan (R, Okla), the bill's primary sponsor, told Psychiatric Times.

Although the legislation is supported by other physician groups such as those representing ophthalmologists and anesthesiologists, the American Psychiatric Association (APA) has been at the front of the pack of the bill's supporters. The APA is still steaming about Louisiana's decision to not only allow psychologists to prescribe drugs, but to call themselves "medical psychologists" as well. The state legislature simultaneously vested oversight of "medical psychologists" with the Louisiana State Board of Examiners of Psychologists instead of the state medical board. Regulations became final in January 2005, as they did in New Mexico for a similar state statute. Psychologists in Louisiana who want to call themselves medical psychologists are required to get specified additional training.

"The term 'medical psychologist' encourages a patient to believe he or she is being seen by a medical doctor when they're really being seen by someone without a medical degree. To me, that is deceptive," said APA President-elect Dr Carolyn Robinowitz. "Psychologists can help with a broken heart, too, but neither would that make them cardiologists. It is fundamentally wrong to subject people in need to substandard--and perhaps even dangerous--care by misleading them."

The Coalition for Health Care Accountability, Responsibility and Transparency (CHART), which is spearheading the legislative lobbying on the bill, did a nationwide survey the results of which indicated that there is significant public confusion about the qualification of health care providers. Highlights from the CHART telephone survey of 1000 US adults found that 59% believe a psychologist is a medical doctor.

The Healthcare Truth and Transparency Act would require the Federal Trade Commission to immediately upon the bill's passage do a study of health care providers who imply that they are physicians; to note whether consumers were harmed; and to highlight state laws that allow the deceptive advertising to take place. A report of the study's findings would go to Congress within a year following the bill's passage.

Kathleen Archer, spokeswoman for the American Psychological Association Practice Directorate, responded, "We believe that members of Congress will recognize that this bill is an attempt to advance a single provider group's self-interest in the guise of 'patient safety,' is bad public policy, and will not be supported."