Many of California's 7,000 optometrists would love to prescribe medications for patients with eye problems.

But, right now optometrists have to refer patients in need of prescription drugs to ophthalmologists. Likewise, nurse-midwives must turn to obstetricians, while psychologists turn to psychiatrists.

Increasingly, however, nurses, optometrists, psychologists, physician assistants and pharmacists are asking why they can't perform this task without permission from medical doctors. They are seeking--and in some states winning--prescription privileges.

The trend concerns physicians, who fear patients may be harmed and physicians may lose their identity as well as some income. But some observers say, like it or not, the emphasis on cost-effective primary care proposed by the Clinton task force on health reform favors using other professions to perform basic health-care functions like prescribing drugs.

Nurses, optometrists, psychologists, as well as pharmacists and physician's assistants, contend that they can save precious health-care dollars if they can write prescriptions for basic illnesses and health problems, thereby saving a patient a trip to the doctor's office.

"This is part of the larger debate on health-care reform," says Joan Meehan, a spokeswoman for the American Nurses Assn., which is lobbying hard for some nursing specialties--such as nurse-midwives and nurse practitioners--to gain the privilege. "If you're looking at increasing access to care and containing costs, allowing others to prescribe is a key part of that."

At the California Medical Assn. in San Francisco, officials are gearing up for what they expect will be repeated challenges to prescription privileges, which they call the "defining" characteristic of MDs.

"This is an issue that will be getting a lot of attention," says Vonnie Gurgin of the CMA.

But Gurgin says the fundamental question before state lawmakers will be: Can these other health professionals be as responsible and effective as physicians at the task?

"There is a paucity of research on this question, and that makes the issue problematic. There is a lot of anecdotal evidence. But that's not scientific evidence."

Although the challenge to prescription privileges has been met with great opposition by physicians in California, other states are doling out the prescription pads to non-medical doctors.