Prescribing PsychologistsDOD Demonstration Participants Perform Well but Have Little Effect on Readiness or Costs Gao ID: HEHS-99-98 June 1, 1999
The military employs 431 psychiatrists and 430 clinical psychologists in 1999 to provide mental health care for about 8 million active-duty members, retirees, and dependents. Ten psychologists who had completed training by June 1997 under the Psychopharmacology Demonstration Project (PDP) were allowed to prescribe psychotropic medications at Air Force, Army, and Navy medical facilities across the country. At the time of GAO's review, they served in positions of authority, prescribed from comprehensive lists of drugs, and carried patient caseloads comparable to those of psychiatrists and psychologists at the same hospitals and clinics. Their clinical supervisors and others were complimentary about the quality of their patient care. However, 10 prescribing psychologists cannot substantially affect the medical readiness of an organization staffed by more than 800 psychiatrists and psychologists. The PDP graduates reduce the time patients must wait for treatment and increase the number of personnel and dependents who can be treated for illnesses with psychotropic medications, enhancing peacetime readiness where they serve. But it is unlikely that the 10 psychologists' prescribing abilities and knowledge of psychotropic drugs would be needed during wartime, when the preferred treatment is rest, counseling, and quick return to the front lines. Over the course of the PDP graduates' careers, the Defense Department will spend an average of about seven percent more (or about $9,700 annually) per graduate than it would spend on a mix of psychiatrists and psychologists who would treat patients in their absence.
GAO noted that: (1) the 10 PDP graduates seem to be well integrated at their assigned military treatment facilities; (2) the graduates generally serve in positions of authority, such as clinic or department chiefs; (3) they also treat a variety of mental health patients; prescribe from comprehensive lists of drugs, or formularies, and carry patient caseloads comparable to those of psychiatrists and psychologists at their same hospitals and clinics; (4) also, although several graduates experienced early difficulties being accepted by physicians and others at their assigned locations, the clinical supervisors, providers, and officials GAO spoke with at the graduates' current and prior locations--as well as a panel of mental health clinicians who evaluated each of the graduates--were complimentary about the quality of patient care provided by the graduates; (5) however, granting drug prescribing authority to 10 military psychologists cannot substantially affect the medical readiness of an organization staffed by more than 800 psychiatrists and psychologists; (6) according to military psychiatrists and psychologists GAO talked to, it is unlikely that the graduates' prescribing abilities and knowledge of psychotropic drugs would be needed during wartime because these types of drugs are not generally the treatment of choice in combat; (7) rather, in treating combat stress, the preferred course of treatment is adequate rest, counseling, and a quick return to the front lines; (8) nonetheless, clinic and hospital officials told GAO that the graduates--by reducing the time patients must wait for treatment and by increasing the number of personnel and dependents who can be treated for illnesses requiring psychotropic medications--have enhanced the peacetime readiness of the locations where they are serving; (9) GAO projects that the Department of Defense (DOD) will spend somewhat more on these 10 prescribing psychologists than it would have spent to provide similar services without the prescribing psychologists; and (10) primarily because of their high training costs, GAO estimates that over the course of the PDP graduates' careers, DOD will spend an average of about 7 percent more (or about $9,700 annually) per PDP graduate than it would spend on a mix of psychiatrists and psychologists who would treat patients in the absence of the PDP graduates.