When Stewart R. Beasley Jr., PhD, began his private practice in 1975, he needed clients. So the Edmond, Okla., practitioner joined the staff at the local Edmond Hospital, thinking it would help him garner referrals. At the time, psychologists in hospitals served mainly as "allied health professionals:" They could treat patients in the hospital, but couldn't sit on committees or oversee patient care.
To meet physicians who could link him with patients, Beasley attended medical staff dinner meetings. "I made it a point to sit at a different table each time so I could get to know different doctors and they could get to know me," he recalls.
The move worked. Not only did Beasley forge relationships that led to a rich array of hospital work including patient care, consulting, teaching and supervision, but he eventually gained full hospital privileges, including the right to admit and discharge patients, at five hospitals. He didn't stop there, though: He also pioneered changes by advocating for legislation that spelled out psychologists' right to be a part of medical staffs, and he helped to rewrite a hospital's bylaws to give psychologists full staff privileges.
"Hospital privileges were kind of uncharted territory at the time, but I thought it was time to get in there," Beasley says. "Having these rights ... gives us a greater say in treating patients who fall within our expertise. Being able to provide patients a continuum of care-from treating patients in the office, to seeing them in a hospital setting if necessary, to providing follow-up care-can make a huge difference in how well they do."
Advocate and activist
According to data APA compiled in 2006, 37 states permit hospitals to give psychologists full privileges and 12 require it.
"Stewart successfully worked with physicians and educated them about the services he provides," says Maureen Testoni, JD, director of legal and regulatory affairs in APA's Practice Directorate.
His success may also have to do with a certain stealthy tenacity, Beasley admits with a chuckle: "I was like a submarine. I got in there silently and deeply, but once I was in there, I wasn't going to stop."
He saw his first opportunity in the early '80s, after several years on Edmond Hospital's allied health staff. The hospital's emergency room was seeing more and more psychiatric patients, and the emergency-room physicians weren't sure how to handle them. They frequently called Beasley for late-night consultations on patients who had overdosed on drugs or for help in placing those who required more intensive psychological services than the emergency room could offer.
The good relationships that ensued emboldened Beasley to take the situation a step further and volunteer to serve on the hospital's emergency room committee-a privilege only allowed to medical staff. He framed his suggestion in a nonthreatening way, saying he simply wanted to help the staff develop a protocol for these patients, not to make any decisions on the physicians' behalf. The hospital approved his request, further cementing an egalitarian relationship with medical staff.
By 1987, Beasley was on the allied staff at four Oklahoma hospitals, and he felt the time was right to address hospital privileges more directly. Together, he and Richard Hess, executive director of the Oklahoma Psychological Association, developed a campaign to pass legislation that would prohibit hospitals from denying qualified psychologists the right to serve on medical staffs.
Soon after the bill passed in 1988, Beasley and his colleague Katrina Bright-Cochran, PhD, decided to test both the law and the medical profession at Mercy Health Center, one of the largest private hospitals in Oklahoma City. Through a lengthy process that involved working with staff physicians, psychiatrists and the hospital administration, and getting approval from the center's executive committee, the team effected a change that enabled psychologists to admit, discharge and head up direct hospital mental health treatment teams-a role that Beasley assumed at a psychiatric unit he helped to create.
These days, Beasley continues to provide a range of hospital-based services at three hospitals in the Oklahoma City metro area. His work includes evaluating patients for organ transplants and bariatric surgery, helping cardiac bypass patients cope with anxiety and depression, and helping people manage pain. He also conducts educational programs to help people manage their children's asthma, stop smoking and cope with grief. In all, his hospital work "has been a great ride," he says.
Barriers without and within
Despite these gains, Beasley sees two obstacles to realizing full hospital privileges in his home state.
One is that two major Oklahoma hospitals have resisted allowing psychologists to obtain full hospital privileges. The other barrier, in his view, comes from the field itself. "A lot of psychologists have chosen not to pursue hospital privileges, either because they don't know how to or because they don't want to be bothered," he says. "When you get on a hospital staff, you don't just get the perks-you also have the downside of the 3 a.m. emergency room calls and the requirements to serve on hospital committees."
Yet hospital privileges carry important rewards, including strengthening psychology's credibility and visibility; increasing opportunities for psychology, such as the chance to provide interdisciplinary care and to practice mind-body health; and expanding the scope of practice to include people who could benefit from psychological care but might not otherwise have access to it.
Fortunately, the hospital-privileges movement is gaining momentum because early career psychologists are more likely to be trained in behavioral health, and more physicians are learning to incorporate psychological factors in their practices. "We now have a common language and a common bond," he says. "It's a great time to work on this issue, not only in Oklahoma," he says, "but all over the country."
Tori DeAngelis is a writer in Syracuse, N.Y.
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