Comparing Psychopharmacological Prescriber Training Models via Examination of Content-Based Knowledge

Abstract

The debate over whether psychologists with postdoctoral degrees in psychopharmacology are adequately trained to prescribe (RxP), has grown increasingly contested over the years. Five states, the U.S. government, and Guam currently allow psychologists with advanced training to prescribe limited medications. The literature is wrought with strong opinions on both sides of the debate. RxP opposers argue that the prescribing psychologists’ training is truncated and less effective than other available options (medical and nursing school); while RxP supporters argue that medical school is essentially overkill for prescribing psychology’s narrow aim, and that nursing schools are less rigorous than the postdoctoral training uniquely designed for psychologists. Comparing each prescriber’s basic competence, side-by-side, via examination, had never been attempted (each has their own licensing examination). This study tested 66 providers: psychiatrists, general physicians, psychiatric nurse practitioners, general nurse practitioners, prescribing psychologists, and general psychologists. Psychiatrist performed the best, followed by prescribing psychologists, then psychiatric nurse practitioners. There was no statistical difference in the performance of these three groups. Non-psychiatric physicians and non-psychiatric nurses—who ironically write 80-90% of psychiatric prescriptions—performed worse than the first three groups, and non-psychiatric nurses performed significantly worse. General psychologists performed significantly worse than prescribing psychologists, indicating that the achieved level of competency is due to postdoctoral training. Arguments that psychologists wishing to prescribe should merely attend nursing school, should be re- evaluated in light of these findings. Prescribing psychologists’ performance is superior to the performance of those trained as nurse practitioners (both family and psychiatric).