State Leadership Conference
Patients with a variety of health disorders would benefit from improved treatment if more psychologists had hospital privileges and were part of hospital medical staffs, said presenters at a 2006 State Leadership Conference (SLC) session. They also highlighted that participation in hospitals and related institutions provides practitioners with substantial opportunities for collaboration with the medical community and potential referral sources.
Psychologists who have hospital privileges have the right to treat patients in the hospital and sometimes to admit them and write orders. Those on the medical staff have the added ability to participate on medical staff committees and vote on hospital policies, such as standards of care and provider credentialing requirements.
Too often, presenters said, patients with mental illnesses fail to receive psychological services that help them manage their disorders. Rather, they are overmedicated to merely suppress symptoms, said presenter Bill Safarjan, PhD, chief financial officer for the California advocacy group Psychology Shield. When psychologists have hospital privileges and are medical staff members, they are better positioned to ensure quality of care and help patients receive rehabilitative psychological services than when they serve only in consultative or ancillary roles, presenters said.
Currently, 37 states allow psychologists to serve as hospital medical staff and 12 require that hospitals permit their presence. However, many states still struggle to enforce the laws and relevant regulations, noted Maureen Testoni, JD, director of regulatory development in APA's Practice Directorate.
At the SLC session, Safarjan and fellow presenter Max Heinrich, PhD, outlined efforts in New York and California to clear hurdles to psychologists' hospital privileges.
Psychologists in New York have been working with legislators since 1987 to pass regulations granting psychologists hospital privileges. Their current approach involves legislation amending an existing public health law, said Heinrich. The bill would add psychologists to the list of health professions who hospitals are prohibited from discriminating against when granting professional privileges.
Psychologists in California are continuing a decades-long battle for independent hospital practice. Recently, as part of their multipronged approach, they formed Psychology Shield to advocate enforcement of the 1990 California Supreme Court victory in CAPP v. Rank that validated psychologists' right to expanded hospital privileges.
Last spring, Psychology Shield convinced the state to finally issue regulations complying with CAPP v. Rank. Organized psychiatry then sued to block the regulations.
In February, a state court ruled that although CAPP v. Rank "may well serve as the authority" for the state to issue the regulations, the state should not have issued the regulations without the normal public notice and comment period. Psychology Shield, in collaboration with the California Psychological Association and the APA Practice Organization, is now pushing the state to issue the regulations by the normal process.
At the workshop, Charles Faltz, PhD, a California Psychological Association leader in the advocacy effort for 30 years, credited the state legislative successes and the CAPP v. Rank victory for providing the legal recognition that assures psychology a seat at the table whenever California's hospital practice policies are an issue.
Indeed, regulatory victories alone won't ensure psychologists' full participation in hospitals, Safarjan and Heinrich noted. Psychologists must work with state officials and individual hospital administrators and demonstrate the expertise that treating psychologists bring to hospital medical staff. They also must help hospital administrators negotiate the changes such regulations bring, since changes often opposed by other medical staff members concerned about their own scopes of practice, they said.
One way to facilitate such change is to increase the number of psychologists who hold administrative roles in health care, noted Heinrich, a director of clinical service at Maimonides Medical Center in New York.
"The passion that's driving me is we really need to do something for the seriously mentally ill people who get hospitalized," said Heinrich.
-D. Smith Bailey
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