Psychologists in Independent Practice

APA Division 42, Psychologists in Independent Practice Responses from Candidates for APA President:

Representation

In our dedication to promote the representation of practitioners in the APA leadership, the Board formalized the process of seeking statements from the candidates for APA Presidency to better guide us all in the election process. A series of questions, developed by Jeff Barnett with input from the Executive Committee, was sent to the candidates. The Board of Directors voted to endorse (without ranking them three professional psychologists: Rosie Phillips Bingham, James H. Bray, and Stephen A. Ragusea. Please be sure to vote in this important election and give these colleagues your top three votes in the order of your preference.

Click on the names below to view their statements

Rosie P. Bingham, Ph.D.

1.  What have been your primary contributions to psychologists in independent practice through divisions, state associations or other organizations?  What, in particular, have been your contributions to Division 42?

First and foremost my contributions to psychologists in private practice have been through my work as a trainer and supervisor. When I established the pre-doctoral internship in psychology at The University of Memphis, I was unwavering in my insistence that assessment be a part of that training. Though we were pressured to drop that training because we were a university counseling center, we kept it and those who have completed the program have been grateful. So I train to the strengths of our private practitioners. I have also supervised private practitioners for licensure. I have served as an oral examiner and conducted continuing education workshops, including ethics and multicultural vocational psychology. . I chaired the Board for Professional Affairs and have attended the State Leadership Conference. Perhaps the most significant contribution to continuing education came during the two years I served as an organizer of the National Multicultural Conference and Summit. I was on the Executive Board for Division 17 when we established a Vice President for Practice and have resolutely supported the practice efforts in 17 and even recruited individuals to run for the office. Divisions 17 and 42 have often worked together because we have so much overlap in membership.

2.  From your perspective what are the two most significant issues facing the practice of psychology?  As APA President how would you address them?

First, the practice of psychology continues to be plagued by public lack of awareness and understanding of psychology. Nor do insurance companies, corporations, and the medical profession fully appreciate what psychology has to offer. We have to continue our efforts to change that. Using the concept that integrates research, clinical expertise and patient characteristics as relevant to effective outcomes, we must educate the public on evidenced-base outcomes. And, in truth, we probably should do more of that kind of education for ourselves. Second, practice and science must function as one body to help determine even more evidence-based interventions and get those outcomes out into the public eye to provide a wider variety of practice interventions that further lift psychology’s credibility. I will continue to support our efforts to make psychology a household and our efforts to increase awareness about evidence-based practice.

3.  From your perspective what are the two most significant issues that psychologists in independent practice are facing in their work lives and what will you do to address them as APA President?

I believe that managed care is a significant issue for psychologists in private practice for two reasons. First, managed care has caused some psychologists to earn less for their services than they did ten years ago. In some parts of the country psychologists say they do individual therapy as a “ hobby ” because they certainly can not earn a living doing it. Secondly, in many instances managed care has contributed to us over pathologizing our clients because of the labels we must use to satisfy various codes.

Another issue facing private practitioners is licensure portability and reciprocity. This issue can cause psychologists to be place-bound and restrained in their ability to work across borders. Further, because of restrictive laws, sometimes psychologists can not offer gratuitous help to people in need even when it is desperately needed.

The states, some divisions, APA, and other organizations are working on these efforts. I will wholeheartedly support those efforts and lend the weight of the presidency to this important work. I will be calling on all psychologists to support lobbying efforts that make it possible for psychologists to practice more freely and perhaps even more prosperously. If our practitioners and our scientists will take on these problems, together we can find solutions.

4. What advocacy roles have you taken on behalf of the practice of psychology and what have you accomplished?

As Chair of BPA, I advocated for all guidelines to be practice friendly. While we need guidelines, we must insure that they are not so restrictive that they overly constrain effective practice. I have lobbied for practitioners to get paid for the work that they do. I just finished a nine month crusade that led me to our university’s Board of Regents to get an increase in pay for our interns at The University of Memphis counseling center. I have participated in responding to practice alerts to congressional representatives and have contributed funds to support efforts like prescription privileges and offered support to training programs that have been threatened with closure.

5.  What do you plan to do for professional practice as APA President?

My theme for this presidential run is Exclusion is Easy but Inclusion is Power! It is my fondest dream to see science and practice working together to solve the major issues and obstacles for both practice and science. I have noted some of the problems for practice above and for science in other places (including funding and publishing struggles). I want to see us take a problem-based, solution-focused approach to at least a couple of the main problems through a summit or a task group. If we build a strong collaborative model then we can use that model to address the major practice, science, and societal issues of the day. In the meantime I will continue to support the work between APA, the National Register, States and others as we work toward solutions to problems

James H. Bray, Ph.D.

I thank Division 42 for providing an opportunity to address independent practitioners. I became involved in APA through state psychology and practice issues. See my website for further information: www.bcm.tmc.edu/familymed/jbray.

1.  What have been your primary contributions to psychologists in independent practice through divisions, state associations or other organizations?  What, in particular, have been your contributions to Division 42?

Contributions to Division 42:
I have been an active member since the division was created. Elected fellow in 1994, written articles for the Independent Practitioner, stood for election for secretary and council representative and served on committees and task forces: Co-chair-Family Therapy in Independent Practice; Rural Psychology; Primary Care; Division 42 representative to the Science Leadership Conference.

Contributions to APA and other practice divisions:

  • Rural Health Task Force and Committee; vice-chair and chair.
  • CAPP Primary Care Task Force.
  • APA State Leadership Organizing Committee.
  • Division 43: President, council representative. Planned the mid-winter meeting with Divisions 42 and 29.
  • Division 43, 46, 55: Treasurer.
  • Division 29, 46, 55: Member at large.
    Contributions to state and local psychological associations:
  • Chair, Texas PSYPAC.
  • Oral examiner, Texas State Board of Examiners of Psychologists.
  • Chair, TPA Family Psychology committee.
  • Houston Psychological Association. Board of Trustees, chair, Legislative Affairs Committee. Psychologist of the Year.

2.  From your perspective what are the two most significant issues facing the practice of psychology?  As APA President how would you address them?


Making a Viable Living. Our greatest challenge is making a reasonable income. The continued cuts in reimbursement for psychological services and for public service undermine our profession.
Addressing Threats to the Practice of Psychology. Many practitioners are struggling with threats to scope of practice from other masters level professions.

What I will do: Insure that APA makes psychological practice needs a top priority. Help create new sources of revenue to fund our initiatives. Increase our state advocacy to deal with threats to our scope of practice.

3.  From your perspective what are the two most significant issues that psychologists in independent practice are facing in their work lives and what will you do to address them as APA President?

Making a Viable Living. Managed care continues to ravage our profession, as they over-regulate and withhold psychological services. With increased mobility, there are unnecessary limitations on practicing in multiple states.

Addressing Threats to the Practice of Psychology. Many practitioners are struggling with threats to scope of practice from other professions and through over-regulation. We can not let an overly rigid evidence-based practice perspective interfere with long held practices in psychology. We need to use our psychological science to enhance our practice, not interfere with our practice.

What I will do:

1. We are a strong and financially viable organization, yet many members are barely able to make a decent living. APA needs to refocus its resources to better support practitioners and their professional needs.

2. We need to re-double our efforts to eliminate managed care through changes in legislation and strategic lawsuits. I will build bridges with other professions and trial lawyers to enlist their help in eliminating managed care.

3. As “all politics are local,” we need more resources to expand our advocacy efforts.

4. Increase our presence in the media and other public education efforts to support psychological practice.

Within APA I take action to deal with these problems. After learning that practitioners from small state associations were required to fund their own travel to attend Council meetings, I introduced an APA Council item to provide APA funding. This was limiting practitioner participation because of financial hardships. This was passed and will save Divisions and SPTAs $1000s.

4.  What advocacy roles have you taken on behalf of the practice of psychology and what have you accomplished?

Advocacy Roles:

  • APA Federal Advocacy Coordinator for Division 43, Division 12; Texas.
  • Fundraiser for AAP. I have raised $1000s for federal candidates and organized AAP fundraisers.
  • Texas PSY-PAC, Chair, 1992.
  • Texas Supreme Court Advisory Committee on Child Support and Child Visitation.

Advocacy Accomplishments:

Federal: I helped the practice directorate successfully lobby on many practice issues: gaining mental health parity, expanding our participation in Medicare, being designated as primary care providers, gaining access to GME and GPE funding, and seminars to the Congress on rural psychological practice. I developed a successful grassroots lobby network in Texas.

In recognition of my efforts I was given the following advocacy awards:

  • Karl F. Heiser APA Presidential Award for Advocacy on Behalf of Professional Psychology, 1994.
  • Special Commendation, Board of Directors, American Psychological Association, 1994.
  • Federal Advocacy Award, APA Practice Directorate,1992.

State: I have been a long-time advocate for psychology within the Texas Psychological Association. As the only psychologist on the Texas Supreme Court Advisory Committee on Child Support and Child Visitation, I helped revise the Texas Family Code. I successfully included psychologists as a separate provider group in the code. This change expanded the role and participation of psychologists in family law matters, expanded practice opportunities in divorce cases, and eliminated legal challenges to psychological testimony

5.  What do you plan to do for professional practice as APA President?

#1 Expand Practice Opportunities. Primary care physicians are the de facto mental health system in the U.S. as they treat over 70% of mental health problems, without any help from psychologists. We can become full partners in the healthcare arena and particularly in primary health care. We have much to offer our medical colleagues to more effectively prevent and treat the major health problems of our nation—but we need to be there. Continue to expand new practice opportunities; gaining prescriptive authority, consulting in legal and business settings, and providing prevention services. We have the scientific knowledge to provide many prevention services, such as psychological well marriage visits, well child and parenting visits. These are important services that the public could benefit from.

The media is a powerful force for public education. As president, I will utilize this resource to further our profession by using the power of the APA presidency to gain access and make comments on public policy issues.

#2 A Culturally Expanded Profession
Expand the number of psychologists to reflect the multi-cultural nature of our society. We need more psychologists who are culturally and linguistically competent to provide psychological services.

#3 Dealing with Disgruntled Members and Nonmembers
After meeting hundreds of psychologists--many had concerns about APA, did not feel that APA represented their interests and dropped out. We need to address their concerns to keep APA strong and powerful. Former APA President Ron Fox taught us that when we circle the wagons to always shoot outwards and not at each other. I will bring this perspective as APA President. We need to work together to support all psychologists.

Alan E. Kazdin, Ph.D.

1. What have been your primary contributions to psychologists in independent practice through divisions, state associations or other organizations? What, in particular, have been your contributions to Division 42?

I have work with the legislators, state commissions, and third-party papers to advocate for improved services, expanded services, and higher reimbursement rates. My current position, with responsibilities for inpatient and outpatient patient care, has provided several opportunities and venues to advocate for our practice and pivotal role in health care. I am eager to expand on this and work with the Division, the State, Provincial, and Territorial Psychological Associations (STPAs), and APA Directorates. I have been involved in critical clinical practice issues facing us nationally, but I have yet to be involved directly with the Division.

2. From your perspective what are the two most significant issues facing the practice of psychology? As APA President how would you address them?

I see one overarching issue with many components. The issue is enhanced employment opportunities. These opportunities require prescription authority (RxA), portability of licenses, licensing requirements (e.g., postdoctoral) that do not constrain new Ph.Ds., and expansion of services that are reimbursed and recognized as critical to the health of our nation’s citizens. These require commitment, strong advocacy, and communication on multiple but united fronts. As to how I shall address these and other issues, please see question 5.

3. From your perspective what are the two most significant issues that psychologists in independent practice are facing in their work lives and what will you do to address them as APA President?

Suitable payment for services and competition from professionals without psychological training in assessment, diagnosis, and treatment I see as the two critical issues. I will underscore the very special training of psychologists, how that is uniquely pertinent to formulating cases, providing a range of services (psychological and increasingly psychopharmacological treatments), and evaluating treatment progress. In addition, psychological services have unique benefits for psychological and physical health care. Psychological services for mental health save the nation money and improve care. We ought to capture much more of health care dollars for our practice. This is a case that has to be made not only in government but also in business and industry where the benefits of psychological services in relation to costs often are more immediately recognized. I can argue strongly for practice issues from my current role in directing an outpatient service and leadership roles in a medical school (Yale University School of Medicine) and community hospital (Yale-New Haven Hospital).

4. What advocacy roles have you taken on behalf of the practice of psychology and what have you accomplished?

I have testified before and worked with legislators, state commissions and legislative committees, and third party payers. In each case, I have lobbied for improved services, a broader range of psychological services, and higher reimbursement rates. I have evaluated state-wide clinical services in Connecticut to convey what is actually provided to children and families and why more psychological services are needed. In all of these efforts, I have conveyed the enormous monetary, personal, and social price that we are paying by the status quo of paltry, diffuse, and poorly reimbursed services. I am not alone in my efforts of course and the palpable gains—we have made several—cannot be attributed to my accomplishments. In advocacy I have learned the Big Five is not a set of personality characteristics but rather Persistence, Experience, Knowledge, Credibility, and Persuasiveness. Together with fellows and members of this Division, I will use my high scores on these to improve the conditions of practice and employment.

5. What do you plan to do for professional practice as APA President?

As APA President, I shall:

  1. Work very closely with this Division, STPAs to facilitate exchange of information on progress and materials (e.g., Commonwealth Fund Report) that will help us make continued gains (e.g., for RxA);
  2. Convene strategic planning practice conferences on critical issues (e.g., RxA, license portability) and involve pertinent parties (e.g., representatives of this Division, STPAs, Department of Defense graduates with RxA, training directors) to chart the next concrete steps to make advances. I have experience with large organizations in developing strategic plans and moving from vision to action.
  3. Be available and involved personally to assist STPAs, task forces, and legislative bodies, advocacy and resource support; the APA President should be on call to the needs of the STPAs and Divisions, and I shall be;
  4. Mobilize and strengthen personnel and financial resources within APA (e.g., Practice, Public Interest, and Education Directorates) in keeping with progress made by previous Presidents (e.g., Pat DeLeon);
  5. Involve patient advocacy groups to help convey the special role of psychologists in their care and for the benefits of RxA; I currently work with such groups, and they can help;
  6. Communicate through task force reports, already available (e.g., from the Practice Directorate) and lobby to convey the cost-effectiveness of psychological services in both mental and physical health care.

I have been fortunate in having experiences infrequently available to clinical psychologists that will make me especially effective and credible in advocating for our practice needs in the full health care arena. I have:

  • Directed in inpatient psychiatric service;
  • Been directly involved in psychotropic medication for patients;
  • Worked with physicians, drug companies, and PhRMA (Pharmaceutical Research and Manufacturers of America) and others central to health-care discussions;
  • Worked with legislators (e.g., State of CT) , health-care organizations (American Hospital Association), and HMOs arguing for improved and expanded psychological services;
  • Directed and continue to direct my own outpatient service for children and families for 20+ years;
  • Led large organizations (e.g., currently chair a medical school department of 400+ faculty and staff; have previously chaired the Department of Psychology at Yale);
  • Teach and advise clinical psychological graduate students including clinical supervision; I have also served as Director of Clinical Training in the APA approved program at Yale;
  • Am involved almost weekly on billing, reimbursement, and fee for service issues with health care management systems; and
  • Conduct research and publish on several treatment issues (e.g., medication effects, role of therapeutic alliance) that make my science relevant to practice.

My experiences with health care are broad; the leadership positions will help make me an effective, informed, credible, and vigorous advocate (please see http://votekazdinapa.yale.edu). My priorities for APA are to augment cultural and diversity perspectives in both science and practice. Improving employment and practice opportunities, and will improve patient care and access to services in keeping with these broader agenda.

Nora S. Newcome, Ph.D.

I have decided to respond with the following general statement to all requests such as yours:
Thanks for writing to me about the APA Presidency. APA is a large and complex organization that serves many constituencies. I believe that the staff of APA, headed by a very capable CEO, does a fantastic day-to-day job of monitoring and addressing the concerns of the various groups of psychologists who comprise APA. My aim in running for President is to provide a unifying face and voice for several over-arching issues: relating science to practice and public policy; organizing “big picture” activities that reduce the fragmentation of our discipline; and, delineating appropriate ways to make evidence-based decisions. Because I am committed to this vision, I have decided to concentrate on these themes in my campaign rather than comment on all of the many particular questions that form a part of the ongoing work of this largely well-functioning organization.

Stephen A. Ragusea, Psy.D., ABPP

1. What have been your primary contributions to psychologists in independent practice through divisions, state associations or other organizations? What, in particular, have been your contributions toDivision 42?

I’ve been in full-time independent practice for my entire career. As a member of Division 42, I am proud to have participated in lots of teamwork for the benefit of the Pennsylvania, Florida and American Psychological Associations.

An APA Fellow of Division 31, I have been an active Fellow of PPA for 26 years serving as President, Clinical Division President, APA Representative, Chair of the Hospital Practice Committee, Membership Recruitment Committee Chair, and Chair of the Practice-Research Network.

I helped preside over the 25-year metamorphosis of a PPA organization that grew from a box of records on Zeta Levin’s kitchen table into an efficient and professionally run state association with its own building in the state capital and eight full time staff. I am proud to have provided workshops at every PPA convention for 24 years, to have written scores of articles for association newsletters, and to have chaired the development of Pennsylvania’s Practice-Research Network. And, I also contributed by serving on the Pennsylvania Board of Psychology.

A 3rd year member of the Florida Psychological Association, I serve on the Board of Directors and as Chair of the Ethics Committee. I these ways, I have contributed to independent practice.

2. From your perspective what are the two most significant issues facing the practice of psychology? As APA President how would you address them?

This question and the next are nearly identical, but I’ll try to draw a clear distinction between them. First, not all practitioners are in independent practice. In private practice, doctors of psychology are given the highest level of respect of all the mental health professions. Our training model and scientific traditions have created this reality.

However, as I said, not every practitioner works independently; some work in places like prisons, hospitals and community mental health centers. Practitioners who work within these institutional settings are often less highly regarded. Why? They are seen as just “providers” who demand more money than social workers and bachelors level therapists. The quality of their work is less important than their cost. That isn’t true in independent practice where the purchaser of mental health care and the patient are the same person.

We need to find ways to bolster the stature of psychologists in these settings so that they aren’t seen as “providers” who are interchangeable with social workers, counselors, and a variety of other less well-qualified mental health professionals. Psychiatrists get paid much more money because they can prescribe and prescribing psychologists will soon change that!

As president, I will support these endeavors.

3. From your perspective what are the two most significant issues that psychologists in independent practice are facing in their work lives and what will you do to address them as APA President?

No doubt here. The biggest immediate concerns are reimbursement and managed care issues. The financial structure of clinical practice has been grievously damaged; practitioners need help because many are in financial crisis. Why should any smart, ambitious, young person invest in 5 or more years of graduate training to make less than a plumber or carpenter? Young psychologists receive their doctoral degrees and then can’t get paid to accumulate post-doctoral hours.
Curiously, we have managed to become regarded as the premier mental health profession while simultaneously presiding over the loss of the financial incentives to support it. Systems are crumbling and APA needs to do much more. Perhaps this need is best expressed by our declining membership.

Soon, managed care is likely to become a historical curiosity. We’d better be ready for what comes after managed-care, be it consumer-driven healthcare, a nationalized single-payer system, or some hybrid. As president, I will guide more of APA’s resources to focus on reimbursement issues. We need to allocate staff and resources more wisely. Financial viability is the rock-solid foundation of independent practice and it demands more respect and attention inside our national headquarters.

4. What advocacy roles have you taken on behalf of the practice of psychology and what have you accomplished?

In 2001 I was honored to receive APA’s Karl F. Heiser Presidential Award for Advocacy, which followed my receiving PPA’s Award for Distinguished Service to Psychology. As I understand it, both of these awards recognized a number of different areas in which I had functioned as an advocate. Included was the work I had done advocating for the practice of psychologists in hospitals.
In the early 1980s I couldn’t admit my suicidal patient to a local hospital. So, I created a partnership and built a 92-bed private psychiatric hospital. The week before we opened, with me as Clinical Director, Medicare reviewers told me I couldn’t admit my patients there either. I spent many years working with what was then the Practice Directorate, and several Pennsylvania legislators to change the Medicare regulations. I also worked with PPA to change necessary laws in Pennsylvania. This took many years and, of course, this was all a team effort. We made a lot of progress in the right direction that actually helped pave the way for prescribing psychologists. I’m proud to have helped accomplish those changes.

I think I’ve also successfully advocated for many other important changes, but that is one of my contributions.

5. What do you plan to do for professional practice as APA President?

Fundamentally, I plan to bring the perspective of a full-time-practicing-psychologist to the presidency. That hasn’t happened for years, and it can mean a great deal. A practitioner, for president, for a change.

One initiative will be good for both practice and science.

Psychologists recognize that science and practice must advance together for either to thrive. Psychology’s research heritage has provided a scientific foundation that allowed psychology to leap ahead of all other mental health professions. However, we must continue to nurture the dynamic interaction between practice and research in order for the field to thrive as a viable science and profession. We need to get our best and brightest working together for the advancement of psychology and society. By having our researchers and practitioners work together in Practice-Research Networks, we can help conduct more relevant research while making practice more powerful.

I led the development of Pennsylvania’s Practice-Research Network to link practitioners with researchers in a mutual enterprise to share expertise and resources. See: Borkovec, T.D., Echemendia, R.J., Ragusea, S.A., and Ruiz, M. (2001). The Pennsylvania Practice Research Network and possibilities for clinically meaningful and scientifically rigorous psychotherapy effectiveness.
I will do the same, on a greater scale, at APA.

 

Copyright 2006 Psychologists in Independent Practice