2011 APA Presidential Candidate Robert E. McGrath, PhD
by Robert E. McGrath, PhD
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?
Fair compensation is increasingly a concern for all healthcare professions, but our value to the emerging health care system is going to depend on how well we establish ourselves as essential to that system.
So far we have done poorly at demonstrating the value of our services, and as long as psychology is an ancillary health service we will remain the underdog in the struggle for compensation commensurate with our level of training. In fact, given growing competition from master's level providers, allowing the current status quo to continue raises serious concerns about the survival of doctoral-level psychology as a vital health care profession.
I see two complementary paths towards greater value to the health care system. One is increased involvement in pharmacotherapy, either as prescribers or as collaborators to primary care physicians. Providing the full spectrum of mental health services, including management of pharmacotherapy, will allow psychologists to take positions of importance within the health care system that to date have been closed to us. The other path is increased involvement in primary care settings, by becoming partners in the integrative care models that are starting to emerge.
Both paths require training psychologists in a set of skills that complements the traditional psychotherapy training, and so will require coordinated effort between the educational and practice communities. These changes must occur soon or we will be left behind, as the health care model of the future is being designed now.
What do you envision to be the best models for delivery of psychological services in a reformed health care system?
Consistent with my previous response, increased involvement in primary and integrative care is central to our future as a profession. Primary care physicians have introduced the concept of the medical home, where the primary care physician plays the role of collaborator to the patient on issues of preventative practices and medical decision-making, and coordinates care for the patient.
Increasingly it is recognized that physicians are not the only health care professionals who should play such a role. In particular, for individuals with concomitant mental disorders, the psychologist can play an integral role in this new doctor-patient relationship, and for this reason the terminology is shifting to talk about the health home or health care home.
The emergence of primary care psychology will parallel the traditional "specialty" practice of psychotherapy, and will require a new set of skills than those traditionally taught to our students, focusing on consultation-liaison, particularly in the area of psychopharmacology and behavioral patient management; implementation of behavioral techniques in medical settings; commitment to evidence-based practices (recognizing that the appropriate evidence base for different types of interventions can vary); and health-related intervention.
I will reiterate an essential point: given that health care reform is on the horizon, we must move quickly to implement this model in time for us to become part of the health care system of the future.