Yeah, that's been debated on and off for years. Obviously, I'm not unbiased, and we feel there's turf to defend.
But the typical argument from the MD side is, if you want to prescribe, go to medical school. It's not a reasonable argument that if there's a shortage of something that requires certain qualifications, then make it possible to let someone else have those qualifications in a shorter time and with different (less, in our minds) required training. It's not fair to change the rules of the game, for those who went through the hardship of qualifying, spent years training, and paid a lot of money to play by those rules, and then someone outside the profession legislates a change in the rules so that someone else can do the same thing? Also, is that really good for the patient? If there's a shortage of commercial airline pilots, do you find people who are peripherally related, and permit a faster path to license them to fly commercial airplanes?
How about other solutions to the shortage? Would it make more sense to make psychiatry more attractive to MDs? It is typically one of the lowest paid three specialties in medicine. Sure, all doctors make a nice salary, but typical med students graduate over $200,000 in debt and are starting their career after residency at age 29 or more. My college classmate who also studied engineering started making a very nice salary right out of college, 8 years before I started my 'real' career. During those 8 years, I went to 4 more years of school and then 4 years of a fairly low paying resident's salary.
I haven't read this whole thread, but I looked up a few pages, and saw a mention of the difficulty in dealing with Medicaid. It's true that many MDs opt out of both at this point, especially Medicaid. When I was in residency, I planned to take medicaid, because I was idealistic, and felt it was important for the system to work that good doctors accepted medicaid. When I started my private practice, I did accept it for a few years. But when I took a hard, honest look at it, I was making less than minimum wage for the time I spent on those patients. They were more complicated and time consuming, had a higher no show rate, and the reimbursement was about 20% of what I could collect out of pocket and 25% of what I could collect from a good insurance plan like Blue Cross.
Also these two incidents were the final straws: 1) medicaid always paid several months later than everyone else, but I once received a payment for a patient I didn't remember seeing. I looked deeper into the records, and I had seen the patient for one visit, 2 1/2 years ago, that's why I didn't remember her. No explanation for waiting 2 1/2 years to pay me, just how it is. 2) I accepted into the inpatient unit, a patient who was witnessed to take a serious overdose of Dilantin (very toxic in high doses) by her roommate, in the group home where she lived, after her BF broke up with her. She denied having done it, said she was fine, and went to bed. She was forced into the hospital by involuntary commitment (a very difficult process), admitted medically for the overdose, was indeed found to have a very toxic level of Dilantin in her bloodstream, was medically treated and then transferred to psychiatry; I ran in to see her on the weekend, treated her and saw every day over about 10 days, got her feeling better, worked with her BF to salvage the relationship, and worked with her mother to make sure she'd be safe when she got discharged, and then was able to discharge her safely back to her group home. I never got paid one dime for that entire admission, and the hospital didn't, either. Why? She had Medicaid, and when Medicaid reviewed the case, they said she was not suicidal, so she didn't fulfill criteria for a psychiatric admission. What? It was a witnessed overdose after a breakup, which was proven with a toxic blood level of Dilantin. That is way more dangerous than someone who says she is suicidal! I requested a formal review in writing by Medicaid. Nope, never said she was suicidal, buh bye. I was enraged. I never saw another Medicaid case after that. The thing is, regardless of how little you are paid or how unreasonable a case may be, you are still held to the same standard of medical care no matter what. If that case went badly, and she walked out the door and killed herself, her parents could sue me because they could make the case that I should have known she would have killed herself; she just attempted a serious overdose, after all, and I should have kept her in the hospital longer. Crazy stuff, and very scary when you're on the other side of it.
I'll add that the VA has been a system that uses PAs and NPs a fair amount, and they do a nice job. But they are tucked into a specific clinic that suits their training, and work under the supervision of an MD who is trained in the same specialty that they're working in. Also, there are both psychologists and psychiatrists who work in primary care clinics and help the primary care provider decide if it makes sense to start medication for depression or anxiety. Anything more than that, such as Bipolar Disorder, Schizophrenia, Substance/Alcohol problems, mixed medical/psychiatric pictures, and both the Psychologist and Primary Care Provider have quick access to a psychiatrist, and from what I've seen, they are more than happy to send those patients on, as it gets too complicated for them. Not that they're not smart enough ... they just don't have the time to spend, the training, or the experience.
One could argue that a Psychologist sees just as many, or maybe more depression and anxiety cases, and that may be true. So allow them restricted ability to prescribe certain limited medications for certain limited diagnoses, such as Prozac for depression and anxiety. I suppose one could be trained for a limited capacity of prescriptions and diagnoses. But would that help the problem? A good PCP can treat first line cases of depression and anxiety, and in fact, primary care providers already write more prescriptions for certain antidepressants than psychiatrists do.
So, that's my one-sided view of it. It's been discussed and debated quite a bit over the years, and it's a complicated and many faceted problem, I know. No easy answers, otherwise it would have been solved a while ago.