by Morgan T. Sammons, PhD
In 2015, the National Register will celebrate its 40th anniversary as a force in professional psychology. When Al Wellner founded the Register, its purpose was to provide a mechanism to identify clinically-trained psychologists. Dr. Wellner presciently termed these psychologists as “health service providers” (a definition included in the most recent model act for state licensure by the American Psychological Association; APA, 2010), to distinguish them from their colleagues who came from more academic models prevalent at the time. In doing so, he answered a very real need for psychology, as there was then no other mechanism to distinguish applied health service psychologists from their academically trained counterparts. The profession immediately responded to this, and within a few years, the Register attracted many thousands of providers. As years went by, circumstances within and outside the profession changed. The Register changed with the times, re-conceptualizing its value model and enhancing outreach efforts. Happily, A very high percentage of Registrants have maintained their association over many years with the organization, and we continue to attract hundreds of new psychologists every year. During my eight-year tenure on the Board of Directors, my colleagues and I marveled at the “stickiness” of affiliation with the Register.
Clearly, the distinction associated with the Health Service Psychologist credential is still a compelling reason to both join and maintain affiliation with the Register. With more than 10,000 currently credentialed psychologists, we are one of the largest professional organizations in psychology. The advantages of credentials verification have been enhanced by the Register’s recognition by many state and provincial boards of psychology as a mobility mechanism. Graduate students and early career psychologists understand the tremendous benefit of “banking” educational accomplishments and permanently documenting internship and postdoctoral experiences. The Register has also made significant leaps forward in terms of consumer outreach, continuing education, and providing documentation of credentials to healthcare organizations and employers. As valuable as these benefits are, however, we are at a point where the Register needs to expand its portfolio.
One of my first initiatives will be to provide our credentialed psychologists and doctoral students with an enhanced informational clearing house for regulatory changes that are of interest to applied psychologists as a whole. As the field has matured, our regulatory structures have become more complex. State laws and regulations governing the practice of psychology mirror the patchwork quilt that prevails in medical licensing laws. As psychology extends its reach into areas that had previously been the province of medicine, and as master’s level mental health providers extend their scopes of practice into areas previously claimed by psychology, the regulatory environment is destined to become even more complex. I have found that opt-in blogs and listservs can be extremely efficient mechanisms for information distribution, and the Register staff and I are already working on mechanisms for the collection and dissemination of regulatory information of interest to the profession.
We need to work more closely together with those entities who, along with APA, represent the largest professional organizations in psychology. The American Boards of Professional Psychology (ABPP) and the Register have complementary purposes: we protect the public by identifying qualified health service psychologists, and ABPP provides evidence of specialty achievement. Likewise, although the Association of State and Provincial Psychology Board’s (ASPPB) task is ultimately one of public protection, ASPPB has significant influence on how state boards write their licensing criteria. All three organizations now provide students with the ability to bank credentials, and all three organizations are recognized, to one extent or another, as mechanisms for mobility. Thus, in many respects, the agendas of ABPP, ASPPB and the Register are complementary, not competitive. In the future, I will work with the leaders of these two organizations to ensure collaboration to achieve common purposes that further the profession.
The Register needs to enhance our health service psychologists’ ability to work in an integrated setting. We know that the Affordable Care Act (ACA) mandates access to a broadly expanded range of mental health services. Indeed, mandates for mental health service provision for Accountable Care Organizations might be, bluntly put, construed as the “full employment act for psychologists.” I have noticed that psychologists, buffeted by managed care and previous cutbacks in state and federal funding, have adopted a consistently pessimistic outlook on the profession and their ability to succeed as practitioners. This is belied by the fact that not only does the ACA mandate an expanded range of mental health services, but that federal organizations, such as the Veteran’s Healthcare Administration, have dramatically increased their hiring of psychologists. In 2003, there were fewer than 1,500 psychologists in the VA system nationwide. Now there are more than 4,000. It is highly unlikely that any doctoral student in psychology has had as robust a panoply of employment opportunities as exist today. Part of the Register’s message must be to reorient the profession to this new reality, and take an active role in shaping the training of psychologists to become true health service providers, able to work fluently in an integrated, often primary care, environment.
Healthcare planners will be required to make choices between those providers whose services are the least expensive and those who have the greatest expertise in delivering specialty mental health services in the integrated care setting. Because our graduate programs must conform to APA requirements of providing a “broad and general” doctoral education, they often cannot provide this specialty education in the doctoral curriculum. It is too expensive and too disruptive to most clinicians to anticipate that they will all seek post-doctoral fellowship training. The Register is skilled at providing continuing education. Careful expansion of this program to include a robust, up-to-date comprehensive portfolio of multi-media materials exposing psychologists to necessary skills to practice in the integrated setting will be a valuable benefit for many psychologists, especially early career psychologists.
We must expand our activities such that we have a seat at the table with national, state, and (often-overlooked) county-level healthcare regulators. In order to do this, we must ally with other non-physician providers working in the integrated healthcare marketplace. The Coalition for Patient Rights (CPR), for example, is an umbrella for over 30 non-physician healthcare provider organizations who seek to expand patient’s access to healthcare services offered by non-physicians. Organized psychology has had a somewhat desultory relationship with the CPR. Such allegiances, however, can expand our policy presence, and the Register can play a vital role in facilitating these relationships at the state and national levels.
Psychology must also expand its initiatives to affect healthcare policy at the state level. Whether one agrees or disagrees with the idea of training psychologists to prescribe, it is indisputable that well-conceived legislative initiatives have had the effect of bringing the serious policy initiatives of the profession as a whole to the attention of legislators. Using similar vehicles, we can further expand the policy presence of psychology to not only benefit the profession, but the public at large. In my current state of residence (California), for example, the Governor’s office is wrestling with the fact that state-employed psychiatrists are by far the highest salaried state employees, yet the state is unable to hire a sufficient number of them. Offering the alternative of appropriately trained psychologists represents a serious policy consideration that advances the interests of all psychologists, not just those who possess training to prescribe. Alliance with professions such as advanced nurse practitioners and physician assistants will not only give us the opportunity to provide training to such professions but will also enable us to bond together to achieve common policy goals.
At the state level, the Register will serve as a resource for psychologists working in state systems and with state-established healthcare exchanges in order to expand services to newly qualified patients with mental disorders. Psychologists in such situations can and should be active in better integrating mental health into state sponsored health delivery systems and can play a vital role in reducing healthcare spending. One such opportunity is illustrated in the state of Missouri. Upon implementation of a Medicaid Health Home Plan, mental health providers in 25 service areas were responsible for integrating and coordinating care for complicated patients. As a result, overall costs went down by 16%, and pharmaceutical costs decreased by almost 25% in the first year (Tobler & Edmonds, 2013). As we know, psychologists can play a crucial role in advising patients and healthcare teams regarding optimum use of psychotropics or non-pharmacological treatment alternatives. The Register can also provide resources to psychologists working in other institutional settings, including the correctional system. Care costs for incarcerated patients is one of the largest drivers of state healthcare spending. Psychologists have a strong presence in many state prison healthcare delivery systems, as well as at the Federal level within the US Bureau of Prisons. It is important that we leverage the combined expertise of this group of psychologists to assist in managing costs.
It is an honor to be selected as the Executive Officer of the National Register. As many of you know, the National Register has had only two Executive Officers in its 40 year history: Alfred M. Wellner, PhD, from 1974 - 1989, and Judy E. Hall, PhD, from 1990 - 2013. As I work with the staff and Board of Directors to further expand the scope and mission of the organization, I will be both mindful of, and inspired by, the accomplishments of these two remarkable psychologists.”
Dr. Sammons begins his term as Executive Officer on July 15, 2014.
American Psychological Association (2010) Model Act for State Licensure of Psychologists . Washington, DC: Author. Accessed online at http://www.apapracticecentral.org/ce/state/model-act.
Tobler, L, & Edmonds, C. (2013). Treating the whole person by integrating care. National Conference of State Legislatures, December, Volume 21, Number 47, accessed online at http://www.ncsl.org/research/health/treating-the-whole-person-by-integrating-care.aspx