Article Appeared -- In The Lobby on 1/21/13



Health care and the health care delivery system are in a period of transformation.  In this atmosphere of change the staid rules of medical education are also being re-examined.  Even in the atmosphere of change the medical establishment would have us believe that medical education cannot evolve since it was recommended by Abraham Flexner in 1910.  Two years of classroom education in the basic sciences followed by 2 years of clinical training still form the basis of medical education.  A closer examination of medical education shows us that it is not as necessary as it would first appear, and not as sacrosanct as organized medicine wants to portray.  The pattern of attending a pre-med program followed by taking the MCAT’s then 4 years of medical education and several years of residency is being challenged.

Brown University, one of the nation’s premiere medical schools, each year accepts a number of
undergraduates who have studied humanities instead of traditional sciences.  A peer reviewed study comparing these students with the students following the more traditional path, found their performance in medical school was equivalent.   Another study found that humanities students made more sensitive
doctors.  Mount Sinai has taken this approach one step further and exempted their humanities students from taking the MCAT’s.  Interestingly they found that these students were more than twice as likely to choose psychiatry as their specialty.

Not only have the requirements to enter medical school come into question some medical schools are modifying the length of medical training.  Several medical schools including Mercer Medical School, Texas Tech University Health Sciences Center School of Medicine and Louisiana State University School of Medicine to name a few, or are developing 3 year medical school programs to train primary care physicians.  This model is not new and was used successfully by the University of Virginia during World War II to train
physicians for the military.

Finally, the way medical schools teach their basic sciences is also evolving and violating the traditional medical model.  Stanford University has begun an online learning initiative using videos
to teach basic sciences.  Mercer University is also using independent study, most of it online, to deliver lectures supplemented by students meeting in small groups to discuss the lecture material.  Ohio State University has taken this a step further and now offers 2 tracks for medical students to learn their basic
skills.  One track follows the more traditional medical school model the other, an independent study path is done almost entirely online.

Medical training, although not acknowledged by the medical establishment, is evolving.
This evolution brings it in line with the realities of the changes and demandsof the new medical care model.  These changes in the training model also make medical training more similar the programs offered by other professions in health care and raise serious questions about the sanctity of the traditional
medical school education.

The rigid path to becoming a physician turns out upon closer examination to be adapting to match current technology,and the current health care environment.  The medical training model, which is over a century old, is being questioned and the answers point to the fact that medical training can successfully be accomplished with students who have a background in the humanities, students who attend less than
4 year of formal medical training and with students who attend some of their classes online.  Acknowledging these changes many of the arguments the medical establishment has against the training of other health care professions begins to sound more like guild protectionism rather than concern about the adequacy of
training or the chronic shortages of trained medical providers.


News Release- American Psychiatric Association


Fewer Medical School Seniors Electing Psychiatry as a Specialty According to the American Psychiatric AssociationARLINGTON, Va. (March 27,2012)—

The number of U.S. medical students choosing psychiatry as a
specialty has been declining for the past six years, according to a report from
the National Resident Matching Program. The American Psychiatric Association
expressed concern that this trend is occurring as the nation faces a shortage
of psychiatrists. The association encourages medical schools to provide more
information and training to medical school seniors to teach them that
psychiatry can be a profitable and rewarding career path.

“In 2010 there was a slight increase in the number of seniors
choosing psychiatry, but overall the trend has been downward,” said John
Oldham, M.D., president of the APA. “We need to reach out to medical students
in more effective ways than simply exposing them to a four-week clerkship on an
inpatient unit, with no follow-up of the patients they have cared for.
Establishing and maintaining ongoing relationships with patients is one of the
key factors that makes psychiatry such a fulfilling career.” Dr. Oldham said
that students need to know what it is like to get to know their patients and
follow their progress over time to know how rewarding the profession can be.

So far reasons for the decline in students selecting
psychiatry are not well known, but James H. Scully, Jr., M.D., the APA’s
Medical Director and CEO, speculated that there could be several reasons. “This
is a very exciting time for psychiatry,” he said, “when we have more scientific
developments in the field than ever before, but this means that the field is
evolving in ways in which the outcome is unknown. It’s a great time for young
doctors to have an impact on what the future of psychiatry will look like.”

Some experts have suggested that there should be more than one
track to an education in psychiatry. Advances in science are leading some
future psychiatrists in the direction of clinical neuroscience, whereas others
would like to focus mainly on psychotherapy. Another issue that most medical
students face is a large burden of student loan debt upon graduation, which
puts pressure on medical students to choose more lucrative careers than
psychiatry, such as surgery.

There are currently about 50,000 psychiatrists in the U.S., a number that is already
inadequate to serve all the patients who need help, especially those in rural
areas of the country. In fact, according to the National Institute of Mental
Health, there are more than 3,500 Health Professional Shortage Areas for Mental
Health, mostly in non-metropolitan areas. In addition, about half of currently
practicing psychiatrists are over the age of 55 and many will soon start



                                                            AN IDEA WHOSE TIME HAS COME


Dec. 12, 2011


Bills have been introduced in both the state Senate and Assembly to allow specially trained psychologists to prescribe medications. I believe that psychologists
who can offer both non-pharmacological interventions as well as psychopharmacology will improve cost efficiency and continuity of mental health care in New Jersey.


I have practiced Obstetrics and Gynecology at the Jersey Shore for 30 years. Like most Ob/Gyn’s, I have developed long term relationships with my patients starting from before they were married, through childbirth and on to menopause.   Our specialty defines the term “continuity of care,” and as such our patients become comfortable discussing everything from traditional Ob/Gyn topics to relationships, children, sexual issues, as well as difficulties encountered as part of aging. Understanding the limits of my practice I often find myself referring my patients to mental health providers. These referrals are an extension of myself and patients expect counseling to continue.  If pharmacologic intervention is indicated, patients expect their therapists to write prescriptions predicated on a thorough evaluation.
Unfortunately there is a shortage of trained mental health prescribers. This shortage has forced many psychiatrists to practice primarily psychopharmacology, minimizing counseling, and treating referrals from therapists. Multiple referrals destroy the trust created in the patient, continuity of care is disrupted and patients suffer.


New Jersey Psychologists cannot prescribe medication. Yet in the military, some government health clinics and other states Psychologists can prescribe. Psychologists have been prescribing safely for over 20 years. Psychologists who prescribe can be expected to rely on medication less frequently than other mental health care prescribers because of their expertise in non-pharmacological treatments. . This can reduce both the cost of treatment and the chance of adverse reactions. Psychologists who can prescribe will provide an additional resource to meet the needs of a rapidly expanding patient base as our military returns to civilian life, and as changes in the health care delivery system results in more individuals able to receive the care.


As a physician I look forward to working with Prescribing Psychologists. I believe

that Psychologists can prescribe safely, be cost efficient, enhance the continuity
of care, and will improve patient care and positive outcomes.


Alan Welt, MD, has practiced obstetrics and gynecology at Brielle OB/GYN for over 30 years.




Michael Harris, MD


May 24, 2011

A bill has recently been introduced in the Assembly that would allow psychologists in New Jersey with additional training to prescribe medications. As a pediatrician who is often frustrated by the difficulties involved in accessing appropriate mental health care, I think this is an idea whose time has come.
The current mental health system is in crisis. Recent studies conservatively estimate that more than 90% of all counties in the United States suffer a shortage of prescribers trained to prescribe for mental disorders, and as a result primary care physicians report mental health is the most difficult specialty to access. As a result, primary care physicians often treat mental disorders themselves without a specialist, a state of affairs that would be unimaginable for a cardiac or cancer patient. I can tell you that even in Bergen County, it is not easy to access prescribers with expertise in the treatment of children’s mental and emotional disorders, and the problem gets
worse as you move away from the wealthier and more densely populated regions of
the state. In fact, several counties in the state do not have a single child
There is a good deal of evidence that psychologists can prescribe safely and effectively. Psychologists are now approved to prescribe in the three branches of the military with healthcare services, and have served with distinction in both recent theaters of war. They are also prescribing in two states (New Mexico and Louisiana), the Indian Health Service, and the Public Health Service. Despite a 20-year track record, not one complaint has ever been filed against a prescribing psychologist in any of those settings. Clearly, psychologists provide an alternative to the existing services.
There is also some evidence that psychologists, who are trained in the entire gamut of treatments for mental disorders, may rely less on medications than other prescribers. It is important to refer people with mental disorders to prescribers with specialized training, but it is also important to refer them to prescribers who have other options for treatment besides medications.
As a physician, I do not believe that primary care physicians and psychiatrists are already struggling to meet the need for medication evaluation among individuals with mental disorders, nor are there enough psychiatric nurses to fill the need.
Psychologists have been found to be safe prescribers. Prescribing psychologists provide an important addition to a mental health system that is incapable of meeting the current need. I have worked for years with psychologists and have been impressed with their professionalism and expertise, and would welcome their help dealing with the medication needs of people with mental disorders.

Michael B. Harris, MD, practices pediatric oncology and hematology and pediatrics at Hackensack University Medical Center.