Structuring departments for greater impact

Psychologists at the University of Missouri consider whether psychology should be spread throughout its health center or kept to one department.

By Lisa Rabasca
Monitor staff

As psychologists seek to integrate behavioral health services into medical settings, they are faced with a quandary: Is it better to create an independent psychology department or to spread psychologists across existing departments such as rehabilitation, psychiatry and neurology?

Psychologists at the University of Missouri?Health Sciences Center at Columbia, Mo., are mulling that question now. A steering committee, appointed by the dean, has begun interviewing the 26 clinical psychologists on staff to determine whether a separate department of psychology should be established.

Psychologists are being asked to evaluate how important their current department identification is to their work and how important an appointment in a department of clinical health psychology would be to their profession, says Gordon Brown, PhD, co-chair of the steering committee.

Clinicians have recommended several changes, including granting psychologists medical staff appointments, developing more research through collaboration with other departments and maintaining a strong research link, says Brown, chair of the health management and informatics department in the school of medicine.

In addition to interviewing psychologists, the steering committee is considering how health-care delivery systems are organized and financed under managed care and are examining population and morbidity trends in Missouri, Brown says. The steering committee hopes to submit a report to the dean by mid-December.

Meanwhile, it has received two proposals for creating an independent department. An initial proposal was submitted to the university by psychologist Danny Wedding, PhD, director of the Missouri Institute of Mental Health (MIMH)?part of the Health Sciences Center at Columbia.

Wedding asserts that a separate department would give psychologists more authority to determine which contracts they enter into, and also to control their own billing?a point of view promulgated by psychologist Edward Sheridan, PhD, a former provost at the University of Missouri, in a speech on psychology?s future in academic health-care centers at APA?s Annual Convention in San Francisco in August.

'With increased competition for both clinical service and research dollars, psychology must plan now how it will better organize itself,' said Sheridan, now senior vice chancellor for academic affairs at the University of Houston.

Subscribing to that line of thought, Wedding says that an independent department at Missouri could improve patient care and increase income by establishing new behavioral health services, including programs to help patients stop smoking and drinking, control stress, lose weight and manage anger. According to his proposal, the new department would focus its research on the efficacy, costs and benefits of behavioral health services, the integration of behavioral health services in primary care and the use of telehealth to provide such services in rural areas.

'The power of the profession is diluted because we are spread across departments,' Wedding says. Currently, psychologists at Missouri work in several departments at the Health Sciences Center at Columbia, including physical medicine and rehabilitation, psychiatry and neurology, child health, and family and community medicine. Many psychologists are also housed at MIMH in St. Louis. Wedding?s proposal would require psychologists to give up their appointments with their existing departments to join the new department.

Brick Johnstone, PhD, director of the division of clinical health psychology and neuropsychology in the university?s department of physical medicine and rehabilitation, agrees that a separate department would offer the psychologists more control over their programs.'Without our own department we remain relatively isolated psychologists with no authority and no opportunities to expand what we do,' he says.

A separate department could also bode well for psychologists? career-advancement, Wedding said. When psychologists from MIMH are considered for promotions or tenure under the current system, they are evaluated by psychiatrists and neurologists. Having an autonomous psychology department would allow them to be evaluated by fellow psychologists.

Niels Beck, PhD, professor of psychiatry and neurology at the University of Missouri, and nine other psychologists recently submitted a second proposal to the steering committee. Under their plan, psychologists currently affiliated with the university would have the option of retaining a primary appointment in their current department and having a secondary appointment in the new department. Requiring psychologists to leave their current departments and join the new department would create unnecessary competition, Beck says.

'There are a number of psychologists in a variety of departments at the medical school who feel that they have long-term relationships with their departments of origin based on trust, mutual respect and a feeling of collaboration with physician department members,' Beck says.'Many of these faculty feel that if they are made to accept primary appointments with the new department, relationships within their existing departments will undergo an irreversible change.'

The full text of Ed Sheridan?s speech is available at www.apa.org/ed/e&t.html.