Perspective on Practice

Welcome to the first in my series of Monitor columns as your new executive director for professional practice. Because only some of you know me, but most do not, I want to tell you a little about myself. I come to APA following 30 years of clinical practice, mostly in the private sector. I entered practice at a time when it was generally easier than now to establish a private practice.

There were not many other mental health professionals in the marketplace, and the economic forces that have so adversely impacted health-care practice were not yet in play.

Like most practitioners, I, too, have wrestled with PPOs, HMOs, managed-care companies, Medicare and Medicaid. These and other forces have threatened practice and severely limited access to high-quality psychological services for many populations, particularly the underserved. Unfortunately, psychotherapy skills are now a commodity available from many sources. Payers have chosen to purchase that commodity from the least expensive vendor and have driven down the market value of psychotherapy. As a result, fees for psychotherapy have not increased in years and have actually dropped in many cases. This situation has been very demoralizing for those psychologists whose primary passion is providing psychotherapy services.

As marketplace forces changed and because I was practicing in a semirural area, I already knew our practice had to be diverse to be viable. In order to do what was dearest to my heart, serve children and their families, we broadened the scope of our practice to include activities such as: fitness-for-duty evaluations for business, industry and public-safety entities; development and management of employee-assistance programs; inpatient psychiatric and substance abuse programs consultation; civil commitment examinations; consultative evaluations for school districts, youth courts and departments of human services; civil forensic evaluations and consultation; and independent medical evaluations for workers' compensation carriers and disability insurance carriers. I found a diverse practice to be stimulating, challenging and professionally rewarding. And it allowed me to continue to treat the patients I wanted most to work with, even with changing patterns of reimbursement.

Despite the changing structure and economics of health care and those changes still to come, I remain passionate and optimistic about the future of psychology practice. I believe that psychologists are the crème de la crème of behavioral health-care practitioners. We have a very large and diverse practice community including but not limited to independent practitioners, institutional practitioners in large interdisciplinary health-care settings, university counseling centers, community mental health centers, state psychiatric hospitals, state and federal prisons, the military services, public health service, community health and rural health clinics, the Indian Health Service, Department of Veterans Affairs and our schools. What a richness we bring to the health-care arena! We are also the experts in human behavior across a broad range of applications and find many of our psychologists using their skills to address critical issues in organizational settings and the legal system.

Our mission in the Practice Directorate is to protect, defend and enhance professional practice. To that end, we will continue to address access to care and reimbursement issues through legal, regulatory and legislative venues; advocate for expanded scope of practice including hospital practice and prescription authority; develop new markets and practice resources for practitioners; and develop increasingly effective public education campaigns. Much of this activity takes place through the APA Practice Organization, the APA affiliate supported by practice assessment money from licensed members.

We are constantly reassessing our objectives and strategies in order to be more responsive to the needs of our practice community. I encourage you to help us by communicating your concerns and ideas either directly or through your division or state, provincial or territorial psychological association. I believe that all psychologist practitioners deserve a fulfilling professional life given their level of education and training and their top-notch services. While we understand that there are challenges for us, particularly in the health-care arena, there are also terrific opportunities. We invite you to work with us and be part of those exciting possibilities!