The 21st century will be an era of unprecedented technological advances impacting upon all segments of society. Currently, more than 11 million Americans telecommute to work. Issues related to providing quality health care via telecommunications, such as interactive electronic patient records, increasingly challenge practitioners. Health-policy experts proclaim the importance of ensuring interdisciplinary care and nationally determined scopes of practice. Our profession has become highly mobile, both physically and increasingly via telecommunications. More than 1,000 colleagues annually request a transfer of their licensing exam score to a new state. Yet, few psychologists realize how difficult it is to get relicensed in a new state.
Increasing our mobility
Historically, the determination of qualifications for professional licensure has been the responsibility of each state. By 1977, all states had enacted some form of psychology licensing law, though a great deal of variation in content existed. APA developed a Model Act for State Licensure to encourage the states to move toward uniformity. The Practice Directorate has worked on mobility with the state psychological associations by facilitating adoption of the Model Act. But, due to necessary legislative compromises, differences remain. With our mobile society, and particularly with the advent of technology, the time has come to appreciate the limitations of the current approach to licensure when dealing with these issues.
The expanding delivery of health care across state lines through the Internet and other telecommunications advances creates a related problem. The law has not necessarily been interpreted to mean that one must be licensed in every state where one engages in telehealth practices, but neither is it clear that such is not the case. Some states specifically address this for our medical colleagues, requiring out-of-state physicians to register with the medical board of the patient's state and be amenable to their disciplinary jurisdiction. APA is taking action in the telehealth arena on several fronts. The Practice Directorate and BPA's Work Group on Professional Practice Issues in Telehealth (chaired by Toni Anker) are compiling a comprehensive report, including thoughtful policy recommendations, and the directorate now has a director of technology policy and projects (David Nickleson, PsyD, JD, firstname.lastname@example.org).
Other models at work
Professional nursing has recognized the necessity of facilitating mobility. The National Council of State Boards of Nursing has endorsed a mutual recognition model for interstate practice, encouraging reciprocal arrangements for licensing and disciplinary action. Its model is the driver's license. Licensure would be recognized across state lines with the practitioner subject to the rules of the state where practicing. Pharmacists facilitate mobility through uniform licensure requirements and their Electronic Licensure Transfer Program (ELPT), which acts as a clearinghouse--transferring a pharmacist's license from one state to another, verifying background information and screening for disciplinary actions. All but two states accept ELPT. The Canadian provinces have been given an ultimatum that the professions must eliminate barriers to mobility of qualified professionals. Our federal government is actively exploring the regulation of telehealth.
The Association of State and Provincial Psychology Boards (ASPPB) has been working over the past several years to create mechanisms that will facilitate relicensure. Three decades ago, ASPPB developed the Examination for Professional Practice in Psychology to avoid 50 different licensing exams being used. Recently, ASPPB developed an individually based approach to professional mobility where a licensed psychologist meeting specific standards can obtain a certificate of endorsement, which facilitates relicensure in other states. There is a provision to waive certain requirements based upon possessing an ABPP diploma, listing in the National or Canadian Registers of Health Service Providers in Psychology and a grandparenting provision for psychologists trained years ago. The Certificate of Professional Qualifications (CPQ) has been operational for 18 months and 17 states and provinces have agreed to accept CPQ for relicensure. The Practice Directorate has worked to increase state leaders' knowledge of the CPQ by hosting a related workshop at its State Leadership Conference. ASPPB also has a credential bank where individuals can store licensure-related credentials, e.g., transcripts, internship ratings, continuing-education certificates. Similar efforts are under way by the National Register, which has since its inception functioned as a credential bank and reports that nine states have health service provider laws with standards similar to the National Register's and four states recognize the National Register for licensing purposes.
I remain concerned that given our historical hesitancy to act proactively, we might find ourselves precluded from effectively participating in this national debate. This is a path that psychology must pursue to successfully compete in the 21st century. Aloha.
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