I applaud recent efforts to address the requirement of a postdoctoral year of supervised experience prior to licensure. I consider this requirement vestigial because recent graduates of doctoral programs at many universities have as many clinical hours pre-internship as my cohort did post-internship over 25 years ago. But it is even worse than vestigial. It is actually harmful to many new graduates and, therefore, to the profession of psychology.
However, undertaking a change in our licensure laws to remedy this situation is both expensive (because changes would have to be accomplished in all 50 states) and risky. When you open your licensure laws for changes you do want, you run the risk of inviting changes you don't want. When I was president of the Massachusetts Psychological Association in the late 1980s we ran into this problem. Today there are many groups who would like to change psychology licensure laws to further their own agendas, such as the New York Medical Society, which recently tried to restrict the scope of practice of psychology, and the graduates of master's-degree programs in psychology who continue to attempt to redefine psychology as a master's-level profession in several states.
There's no quick fix
But even more fundamentally, hastily changing the laws runs the risk of creating a solution that is good for today but bad for tomorrow. As we all know, the future is coming very fast. Witness the dramatic changes in our society in terms of its aging and ethnocultural diversification, and the informational-technological-communicational revolution. The profession of psychology is evolving in response to these societal changes. Hence, I would argue that we need to get a better handle on how the profession is evolving, and then change both the sequence of training and licensure in a considered and coordinated manner.
There are a number of changes within our profession that have not been fully discussed and understood in terms of how they will impact the training sequence and licensure. I am speaking of the increased involvement with psychopharmacology, the movement to view psychologists as primary health-care providers, the evolution of the profession in terms of a broadly expanded scope of practice, the development of new specialties not yet accredited by APA's Committee on Accreditation, the growth of telehealth, and the use of the Internet in training and service delivery.
But even more important are the marketplace issues. I am not only speaking of the downside--the negative impact that managed care has had on psychological service delivery--but also of the potential upside--namely the opportunities that can come with the next evolution of the profession into an expanded scope of practice. It cannot be emphasized enough that this evolution will entail the development of roles that do not now exist in health care, schools, the courts, the correctional system, businesses, etc.--in the numbers that psychologists entered the role of outpatient therapists in the 1970s and '80s. For example, clinical health psychology has a limited number of positions in academic health centers, but we have not begun to tap the potential demand for this specialty as reflected in the fact that 40 percent to 70 percent of all visits to a physician are for problems of a psychological nature.
Preparing for the future
Hence, before we undertake the expensive and risky process of changing licensure laws, we need to critically re-examine the training sequence in terms of how we can prepare psychologists not only to function in these new roles, but also to create them. I do not mean to suggest that we postpone this process indefinitely. We all sense the urgency and need to act quickly. Fortunately, APA's Council of Representatives recently approved the establishment of a Commission on Education and Training Leading to Licensure in Psychology that is expected to move quickly in concert with groups of educators, trainers and regulators to find solutions to these pressing problems.
Ronald F. Levant, EdD, is recording secretary of APA's Board of Directors and dean, psychology, Nova Southeastern University.