OCPS Psychiatrists Unite Against Threat to Patient Safety

As physicians, Orange County Psychiatric Society psychiatrists are dedicated to the preservation of patient safety and the highest standards of patient care. Pursuant to these interests, many psychiatrists are becoming increasingly concerned about the progressive expansion of the scope of practice of non-physicians. This expansion is apparent when individuals who are not physicians (M.D.’s) are permitted to practice medicine without a medical degree, thus jeopardizing patient safety and compromising patient care.

What is a medical degree, and why is it important? A medical degree identifies a physician/medical doctor/M.D. who has successfully completed 4 years of formal medical school (after graduating college). These four years of medical school includes 2 years of supervised direct patient care primarily in a hospital setting. Most practicing physicians have also completed an additional 3 or more years of residency, which is intensive post-medical school medical training in a specialty (internal medicine, pediatrics, psychiatry, etc.). During their training, resident physicians are directly responsible for the care of patients, with ongoing supervision and didactic training. Psychiatrists are required to complete at least 4 years of residency after medical school. This psychiatric residency usually includes further training in internal medicine, pediatrics, neurology, as well as general psychiatry, psychopharmacology, and psychotherapy. One can recognize a physician by their profession designation—either an M.D. (Medical Doctorate) or D.O. (Doctor of Osteopathic Medicine).

Because of this background, psychiatrists are physicians who are uniquely qualified to diagnose, manage, treat, and prevent complex medical conditions, including mental illnesses, using the full range of available treatments, including psychotherapy (“talking therapy”) and medications. Any training that does not meet the standard required of fully trained psychiatrists gives the non-physician practitioner a dangerously incomplete understanding of emotional, behavioral, and personality problems, their myriad medical and non-medical causes, and their appropriate treatments, including the administration of medications with their associated risks and side effects.

In short, medical treatments should be administered only by those people who are fully qualified to do so. Increasingly, legislation and procedural rules and regulations are being promulgated that allow untrained or under-trained practitioners such as psychologists, optometrists, and even pharmacists, none of whom are physicians, to manage medical conditions. Psychologists, who have a Ph.D. or Psy.D. degree, are not trained or qualified to prescribe medication or to make certain other critical decisions in the management of mental illness…this is only within the scope of practice of psychiatrist-physicians. Similarly, optometrists are not trained or qualified to treat medical eye conditions…this is within the scope of practice of ophthalmologist-physicians.

Already, patients have been harmed by the inappropriate practice of medicine by non-physicians, as reported in this article from the Orange County Register. Eight veterans lost eyesight when their medical eye condition (glaucoma) was treated inappropriately by optometrists, who are not physicians, but who were operating within a physician's scope of practice. This is an unfortunate example of what may happen when individuals without a medical degree or medical license begin to practice medicine.

Orange County Psychiatric Society (OCPS) psychiatrists, together with the American Psychiatric Association (APA), the California Psychiatric Association (CPA), the American Medical Association (AMA), and the California Medical Association (CMA), are committed to reversing this disturbing trend. Through tireless advocacy and education these organizations have been successful in protecting the safety of patients and fighting the assignment of prescribing privileges to non-physicians in California and several other states, although such dangerous legislation has been passed in other states such as New Mexico and Louisiana.

What can you do? Psychiatrists must make their voices heard by contributing to organized psychiatry's efforts to advocate and educate, and can do this most effectively by joining OCPS or other district branches of the APA. All physicians can make a contribution by joining the CMA and the AMA. Members of the general public can write letters to state legislators and the governor of California expressing their opinions, and spread the spoken or written word to other people. It is incumbent upon us all to speak out, for the voices of knowledge and reason must be persistent and omnipresent in order to combat misinformation and ignorance.