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Division 42 Independent Practice Research Network: Initial Findings

Professional Practice

Jennifer Salib, M.S.
Indiana State University
Michael J. Murphy, Ph.D.
Division 42 Emerging Patterns of Practice Committee

The simple fact is little systematic data are available about important dimensions of the independent practice of psychology. We regularly provide considerable information about ourselves and our practices to managed care organizations for credentialing and re-credentialing. This occurs even more frequently when we submit billing and utilization review material. As a result, these payers have much more information about individual practices than the psychologists themselves and a better grasp of important aspects of practice than is available to any other group. The disadvantage for private practitioners arising from the absence of data from a business perspective is made worst because research data into effectiveness of psychological services traditionally neglects experienced psychologists working in independent practice settings.

In response to these trends, the Division’s Emerging Patterns of Practice Committee has initiated the Independent Practice Research Network (IP-Net). The goal is to develop a system that will provide accurate information about the private practice of psychology including:

• Patterns of practice organization and management
• Practitioner career paths
• Service delivery and payment systems
• Market factors affecting independent practice
• Practitioners’ attitudes and opinions regarding issues affecting practice and public policy
• Long-term goals include establishing procedures and methods for research on the effectiveness of clinical services in private practice settings.

Initial Steps

The first stage of the project was to develop and evaluate methods employing Web-based data collection. Use of online methods is efficient and cost-effective but there is little research on how online surveys may affect findings. In the process of collecting data about private practitioners we are evaluating data collection issues such as response rate, representativeness of the sample, and management of the database and Website. The first study examined the samples that responded to a questionnaire either online, or by traditional mailed paper-and-pencil, on factors such as personal and practice characteristics of the psychologists and the communities in which they work. We were particularly interested in ensuring that data from participants who responded online are equivalent to data from those who responded by mail, as well as the relationship of both samples to the available data about Division 42 members.

This article reports on our initial findings related to:

• The characteristics of samples that choose to respond online and by mail method;
• The relationship of the samples compared to Division 42 members on variables available from the APA database;
• The personal and practice characteristics of respondents, and systematic relationships among those characteristics; and
• The respondents’ use of technology for office management and service delivery, as well as their attitudes toward technology.

Procedures

The reference sample began with 2,000 randomly selected Division 42 members who were asked to volunteer to respond to a series of questionnaires, and could elect to participate either online or by mail method. Participants had to be willing to respond to surveys up to eight times a year. It was our hope to design each survey to be completed in less than 15-minutes. The database was designed to protect the participants’ confidentiality. Participants are provided with summary data compiled after each survey.

Of the 2,000 Division members contacted, 265 or 13% agreed to participate. Of the volunteers, 130 (49%) indicated they would respond online and 135 (51%) by mail. It is notable that 13% of the initial sample willing to participate is considerably less than the usual response rate to surveys conducted by the Division, which in the past has been closer to 40%. We are not sure what accounts for the difference but suspect that the commitment to respond over time affected willingness to participate, and that the presence of an actual survey may encourage responding.

We have completed the first survey and are collecting data for the second at the time of this writing. The second survey addresses marketing activities and services provided. A significant methodological concern of the second survey is the response rate for participation in a series of surveys. This will have a significant impact on our ability to develop a comprehensive and representative database. We are addressing concerns about response rate by re-contacting volunteers who did not respond. In the future we will be recruiting volunteers, and are in the process of developing the software to collect data for several surveys at the same time and to track respondents.

Initial Findings

The initial survey collected basic descriptive information about the participants, their practices, and information about technology use. We also obtained information about the communities where participants work by using information in the US Census databases according to zip codes of practice location provided by respondents.

We received a total of 161 (8% of random sample) responses (86 by mail and 75 online) over a four-week period, which is far smaller return than we had hoped. Four people from the online and 2 people from the mail group had to be eliminated from data analysis due to inclusionary criteria for this phase of the study. We compared characteristics of respondents to those of the original sample of 2,000 and to the APA Research Office data on Division 42 members, including gender, race, age, degree, number of years licensed, and area of the country in which they practice. Table 1 summarizes the data on our sample with APA data and reveals that the percentage of those participating in the study closely matched the figures for the Division as a whole. The exception is that our sample was selected to insure that the participants’ primary employment setting was in independent practice. Therefore, the percentage of working in that setting was high than the figures for the Division as a whole. This is a very positive finding regarding the representativeness of the sample. However, we must also acknowledge that the total number of participants is relatively small and when we try to make more targeted comparisons the cell frequencies can be quite low.

Table 1. Comparison of Participant Characteristics from Total Volunteer Sample, Random Sample and Entire Division 42 Membership Variable Total Volunteer Sample Division 42 Membership

We also found that the characteristics of those who responded online are very similar to those who responded by mail method. Tables containing these data have been placed on the Division 42 Website (you can access the website and obtain access to the tables in the IP-Net area at www.divsion42.org).

The demographic statistics for the Division have been quite consistent over the years. Particularly interesting is the age of Division members (M = 56.6, SD = 10.6) and the relative absence of racial and ethnic minorities.

Eighty-nine percent of those in our study reported that their primary employment setting was independent practice with the majority in solo practice (51%). The percentage of solo practitioners increases when we include the 14% who are in sole practice but work in settings with other practitioners and share expenses. A very small percentage of the respondents are employees of group practices (3%) but a substantial number are in group practices either as partners (4%) or in a corporate structure (16%). The remaining respondents (11%) reported a variety of other primary work settings. Please see the Website for more complete information about the online and mail groups and their comparison to the Division 42 data.

Table 2 summarizes practice characteristics of the total sample. There were no significant differences between the online and mail group for any of the variables except average income. The online group reported significantly lower average income (M = $81,388, SD = $40,292) than the mail group (M = $107,000, SD = $48,696) but the median income for both groups was $100,000. We also found that average income was significantly lower (t=2.49, p<.05) for women (M = $92,519, SD = 40,361 compared to men (M = $111,662, SD = $45,219). The median income for women was $100,000 and the median income for men was $102, 600. We need to collect additional information to explain these differences but the relatively high standard deviations suggest differences in number of weekly patient contacts may be a significant factor and subsequent surveys will look more closely at these issues.

Table 2. Practice Characteristics from Responses to Surveys for the Total Sample

A main focus of this study was participants’ attitudes toward technology and their use of technology in practice. In terms of current technology use in practice, respondents in the online group, not surprisingly, reported higher rates compared to the mail group. Table 3 presents data on technology use in practice for the online, paper and pencil, and total group.

The results obtained in the present study demonstrate increased use of technology compared to figures reported by McMinn et al. (1999) who reported 57% use for billing (versus 80% in this study), 23% use for testing (versus 46% in this study), and 22% use for maintaining patient files (versus 31% in this study). Results reported in this survey also had a higher rate of reported use of the Internet for therapy (7%), compared to the 2% use reported by VandenBos and Williams (2000).

Table 3. Current Technology Use in Practice from Responses to Surveys for Online, Mail, and Total Sample

This study also examined the relationship between scores on the Attitude Toward Computers Questionnaire (ATCQ, Jay, 1989) and amount of technology use, as well as mode of responding (online or mail). The ATCQ has seven dimensions: (1) comfort, (2) efficacy, (3) gender equality, (4) control, (5) dehumanization, (6) interest, (7) utility, and a total score. Fifty-four out of 69 (78%) people from the online group and 76 out of 84 (90%) people from the mail group responded to the measure. As might be expected, the online group reported significantly more positive attitudes in all areas, with the exception of gender equality, where there was no significant difference between the groups. However, the practical implications of the differences are uncertain because differences, while significant did not suggest a substantially different attitude toward technology. We also found that more positive attitudes toward technology were associated with greater use.

Conclusions and Future Directions

The current study provided considerable information regarding the use of online questionnaires for data collection. We have learned that the apparent ease and low cost of online surveys is balanced by a number of limits. Our most important findings are related to response rates. We will be looking at ways to increase response rates and increase the sample sizes.

We found few significant differences between those responding online and by mail in terms of personal and practice characteristics, with both composed of participants representative of Division 42.

We found that technology use by those in independent practice focuses on administration and communication. Clinical applications are noted in the area of assessment but there has been very little incorporation of technology into treatment.

A more extensive presentation and discussion of the findings from the present study is available on the Division 42 Website. Furthermore, we anticipate that findings from the second survey examining services provided and marketing strategies will be placed on the Division 42 Website by the time that this article is published and invite those interested access the data there. We also invite any comments and suggestions and they can be forwarded to practice@indstate.edu. Finally, we acknowledge with gratitude the time and effort of participants in the research sample.

References

Jay, T. (1985). Defining and measuring computerphobia. In R. E. Eberts & C. E. Eberts (Eds.), Trends in ergonomics/human factors II (pp. 321-326). Amsterdam: Elsevier Publishing.

McMinn, M. R., Buchanan, T., Ellens, B. M., & Ryan, M. K. (1999). Technology, professional practice, and ethics: Survey findings and implications. Professional Psychology: Research and Practice, 30, 165-172.

VandenBos, G. & Williams, S. (2000). The Internet versus the telephone, what is telehealth, anyway? Professional Psychology: Research and Practice, 31, 490-492.

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