Psychologists are promised equal chance at VHA roles

Reorganization of the agency offers new opportunities for psychologists.

By Rebecca A. Clay

The Veterans Health Administration (VHA) has reassured APA that psychologists will get the same chance as psychiatrists to land new leadership positions expected to open up with reorganization of the agency.

Having been promised parity before, only to see psychiatrists gain the lion's share of leadership roles, APA is exerting pressure on top VA officials to ensure genuine equal opportunities for psychologists and psychiatrists.

For the first time, the system's top mental health position may be open to psychologists as well as psychiatrists.

'We want to see genuine opportunities for psychology in the VA's changing health-care system, not simply lip service given to psychology as the system changes,' says Russ Newman, PhD, JD, executive director for practice at APA.

A level playing field?

APA's Practice Directorate has campaigned for leadership parity between psychologists and psychiatrists since the VA started reorganizing the VHA in the mid-1990s. When the deputy chief consultant of mental health position sat empty for three years, for example, APA worked hard to convince the VA to fill it with a psychologist. The VA eventually chose psychologist Mary Jansen, PhD. But when Jansen was recently detailed to the World Health Organization to direct a psychoactive substance-abuse program for the next two years, the prospect of her absence renewed psychologists' concerns about having no one to represent them at VA headquarters.

There have been disturbing signs out in the field as well. Although psychology, psychiatry and other mental health disciplines have been hit equally hard in terms of personnel cutbacks, psychologists are not getting a fair shot at new leadership positions, say psychologists within the system.

An APA survey of psychology leaders in 59 VA facilities found that psychologists headed only 11 percent of newly integrated mental health departments while psychiatrists headed a whopping 75 percent. Even worse, psychologists were not even considered for top leadership positions in 60 percent of the reorganized medical centers. According to Rodney R. Baker, PhD, psychology service chief at the South Texas Veterans Health Care System in San Antonio, a VA Psychology Advisory Committee survey of 99 facilities raised similar concerns about equity.

The case of Robert C. Gresen, PhD, offers a perfect example.

Before Milwaukee's Clement J. Zablocki VA Medical Center underwent reorganization, Gresen served as chief of the center's psychology service. Then reorganization collapsed discipline-specific 'services' into generic 'product lines.' In Gresen's case, that meant that the center's once-separate psychology service, psychiatry service and other mental health services merged into a single 'mental health product line' offering mental health services as its product.

For two years, Gresen co-managed the mental health product line along with the former psychiatry service chief. Then a new medical center director took over and announced that only physicians should head product lines. Gresen was forced to step down.

'They basically said it wasn't reflective of any performance issues,' says Gresen, past president of the Association of Veterans Affairs Psychology Leaders (AVAPL). 'I just had the wrong degree.'

Advocacy efforts

This evidence that psychiatrists have become the default option for leadership positions at the network and medical center levels has alarmed APA.

'The assumption has been that all of the professions involved in the mental health product line are equally able to provide leadership,' says APA's Newman. 'If that's true, it's important for psychologists to realize some of those leadership positions. Otherwise what you've really done is place psychologists under psychiatrists and called it a generic mental health product line.'

APA recently shared its concerns with VHA Under Secretary for Health Kenneth W. Kizer, MD. In his response, Kizer pointed to a 1995 letter he had sent to APA and U.S. Sen. Daniel K. Inouye (D-Hawaii) affirming his belief that 'the most qualified individual, regardless of professional discipline (i.e., psychology or psychiatry), could be selected to provide leadership of any integrated department of mental health....'

Yet the VA doesn't deny that psychiatrists have received most of the new leadership positions so far.

'Not all the searches and appointments have been done fairly, and in a good number of cases, there simply was no search,' admits psychiatrist Thomas B. Horvath, MD, who holds the top mental health position at VA headquarters. 'I've seen it too many times to say otherwise.'

Horvath is trying to change that. Although he no longer has power over appointments, he has been able to persuade many of the VA's medical centers and networks to use more equitable methods for choosing leaders.

'When we haven't been able to induce change, we have certainly managed to induce guilt,' says Horvath, a long-time advocate of parity between psychologists and psychiatrists.

Horvath also co-chairs a subcommittee set up to examine leadership issues in the reorganized VA. Part of the VHA's Executive Resources Board, the subcommittee will, in the long run, propose a mechanism for moving psychologists and other 'allied health professionals' into leadership positions previously restricted to physicians.

Although Horvath is leaving his position in January, his influence will be felt even after his departure. Thanks to his lobbying efforts, APA is hopeful that for the first time ever the VA will open his job as chief consultant for the Mental Health Strategic Healthcare Group to psychologists. And in the meantime, Mary Jansen's job of acting deputy chief consultant should soon be filled-by none other than Robert Gresen, who will assume her duties during her two-year absence.

'The timing is perfect for a psychologist to become chief mental health consultant because the VA is trying to reassure people that everyone has an equal shot at leadership positions,' says Randy Phelps, PhD, assistant executive director for professional issues at APA. 'We want to make sure lots of well-qualified psychologists throw their hats in the ring for the job.'

Preparation for leadership

Psychologists are already preparing themselves for new leadership opportunities. Last January, APA and AVAPL co-sponsored a meeting in Dallas designed to help psychologists seize the new leadership positions created by reorganization. A second Dallas meeting will take place April 30 through May 1, 1999.

The first meeting is already bearing fruit. Seven working groups have been tackling projects ranging from improving communication among VA psychologists to assembling a resource directory of innovative programs and psychology leaders within the VA system.

The Task Force on Defining Leadership Competencies for Leaders in the New VA has already submitted recommendations to AVAPL, which plans to distribute the report to its members. The task force's goal was to clarify the skills psychologists need to assume the new leadership positions created by reorganization now that there's no longer a clear career ladder for them to climb. The competencies identified include personal mastery, interpersonal effectiveness, customer service, systems thinking, creative thinking, technical skills, organizational stewardship, flexibility and strategic planning.

It's not that psychologists don't already have these skills, emphasizes task force chair D.C. Sadow, PhD, chief of the intensive psychiatric community-care program at the VA Hospital in Bedford, Mass. The very nature of psychologists' training ensures that they do, she explains.

But the report discusses how such skills can be developed at all career stages.

'There's a lot of anxiety about the reorganization,' says task force member Richard A. Carothers, PhD, chief of psychology at the VA Medical Center in Oklahoma City. 'Instead of aligning ourselves with that fear, we've got to align ourselves with the idea that there are opportunities here. The better prepared we are to seize those opportunities, the better off we're going to be.'

Rebecca A. Clay is a writer in Washington, D.C.



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