Want to be a medical doctor?

After four years of college, you take the Medical College Admissions Test. If you do well enough, you get accepted to a four-year medical school. The test is hard. Many don't make the cut.

The first two years of medical school involve rigorous classroom work. In the last two years, you rotate through the major medical specialties, working with patients under an experienced physician's supervision.

Then you take another test and apply for hospital-based residency programs in your preferred specialty. These are at least three years; some specialties require up to eight years of residency training before you are licensed to practice.

It's a long haul, and all that medical training either means something or it doesn't. And that's why we have concerns about a bill currently in the state Legislature to give psychologists - who are not medical doctors - the authority to prescribe psychotropic drugs, including controlled dangerous substances.

The bill has reignited the always simmering feud between psychologists and psychiatrists - who are medical doctors.

The psychologists say that giving them the authority to prescribe medications would make these often valuable drugs more available to people who could benefit from them. Psychiatrists deny that there is any shortage of psychiatrists in New Jersey or any access problem. "There are plenty of psychiatrists in this state - you can't throw a head of arugula without hitting a psychiatrist," Dr. Rusty Reeves, the director of psychiatry for the state prison system, told NJSpotlight.com.

To be fair, the bill - A2419 - is carefully crafted. To obtain the authority to prescribe these drugs, psychologists must have a Ph.D and must have completed a master's program in psychopharmacology or its equivalent.

But that doesn't amount to four years of medical school and four years of residency. As the psychiatrists arguing against this bill note, their specialty is complex, and psychotropic medications can affect a host of organ systems in the body - areas in which psychologists have little if any training.

Of course, we suspect that as with all such bills allowing one profession's scope of practice to encroach on another profession's scope of practice, this is really about money. Neither side would be so crass as to say that outright. But remember how optometrists (who are not medical doctors) and ophthalmologists (who are medical doctors) went at it a few years ago in New Jersey? These aren't mere academic disputes. Giving psychologists the authority to prescribe medications means more patients for them and fewer for psychiatrists.

But the psychiatrists have the better argument here - particularly when you consider the growing concern that psychotropic medications are already being overprescribed, particularly to children.

Psychologists certainly play a valuable role in the health care system. But it is difficult to see why it is necessary to give them the authority to prescribe these complex medications.

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