extensive additional training for psychologists to qualify for this privilege, including a 400- hour practicum supervised by a physician, it remains to be seen how many psychologists will qualify, and how many of them will practice in rural areas. New Mexico’s psychologist prescribing law must be monitored closely, tracking the number of psychologists who qualify, both urban and rural, as well as shifts in practice locations. The availability of lower-cost oversight of psychotropic medications is likely to be of interest to managed behavioral health organizations, who may, in turn, create increased incentives for prescribing psychologists to practice in more populous areas of the state, reducing the likelihood that they will serve rural areas.
This study has investigated scope of practice, and has focused on a short list of specific services that each profession is permitted to provide. This approach has not allowed us to comment on the differential needs of the clients receiving these services, which may be better addressed by one profession than another. For example, while a practitioner may be licensed to provide all of the core mental health services, he or she may not be trained to intervene in a psychiatric crisis involving a patient with a severe mental illness. Some professions may, in fact, be better prepared to care for specific populations of clients defined by diagnosis, need, or cultural factors. In the struggle for independent practice and reimbursement, such issues are likely to be presented as “quality” issues. If reimbursement were not a contentious issue for some of these professions, perhaps the guild behavior we have identified could be redirected toward informing consumers and payers of the strengths of each profession.