2011 APA Presidential Candidate Donald N. Bersoff, PhD, JD
by Donald N. Bersoff, PhD, JD
Fair compensation is a major concern for psychologists working in a variety of work settings. What programs or activities would you pursue to address this concern?
As I go around the country talking to practicing psychologists, the one question I am most frequently asked is what is APA going to do about ensuring that clinicians receive fair compensation for their work.
It is fine, they say, to advocate for integrated health care but there are thousands of practitioners who labor on behalf of patients in private offices who increasingly find it difficult to support themselves, their practices, and their families.
The dilemma is that as the country is about to undergo transformational change in the provision and funding of health care, cost containment is a central concern.
Unfortunately, collective attempts to set fees by professional organizations run afoul of the federal antitrust laws. But there is no bar for the APA Practice Organization's Government Relations staff advocating for enhanced Medicare recognition and adequate reimbursement for psychologists during the ongoing negotiations regarding health care reform.
Nevertheless, successful advocacy cannot be accomplished by APAPO alone. It is imperative that APAPO work with other like-minded stakeholders. Psychologists are the best trained of all mental health professions and the one most interested in demonstrating the efficacy of empirically-validated interventions.
We must convince these stakeholders that psychologists can provide such interventions in the most efficient, cost-saving way, even if the hourly charge is higher than that of lesser-trained mental health professionals. Our advocates should not only be those involved in health and mental health care, but must also consist of consumer groups, labor organizations, and business groups.
What do you envision to be the best models for delivery of psychological serives in a reformed health care system?
A decade ago, a prominent physician stated, "Mental health care cannot be divorced from primary medical care, and all attempts to do so are doomed to failure." This reality is even more true today. Potential patients, however, still feel the stigma of attending a mental health center, causing mental illness to go under recognized and untreated. Thus, in any reformed health care system, APAPO must advocate for the expansion of the focus of traditional psychology practice to include the concept of integrated health care—with the assurance, however, we will not abandon the thousands of current practitioners who provide treatment in their private offices.
As assurance that there is genuine integration, it is imperative that there be a correlative national effort to secure hospital privileges for psychologists. But beyond serving those with serious mental illness, psychologists should have a major role in health promotion, particularly with underserved populations in underserved areas. We should advocate for practitioners to be involved in illness prevention, illness amelioration, and positive psychology. If integrated health care produces anything meaningful for psychologists, it should include advocacy for prescription privileges, of which I am a cautious proponent.
There is the concern that prescriptive authority will medicalize psychology practice, but the reality is that almost all prescribing psychologists combine administration of psychotropic medication with psychotherapy—a practice deemed most effective for most serious mental illnesses.
Finally, we must begin to integrate technology into our practices, taking advantage of carefully considered legal and ethical use of telehealth systems.