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Masters vs. Doctorate Debate |
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Professional Practice |
Stanley Moldowsky, PhD and Tommy T. Stigall, PhD |
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Part 1. Stanley Moldowsky: First, let us understand. Psychologist is a protected title by law in almost every state. It is defined by a Doctoral Degree in Psychology, including a dissertation, and an internship. As such, there is no such thing as a “Masters Psychologist”. There are various masters degrees in Psychology but those graduates cannot call themselves Psychologists legally. I know there is an organization who is working to obtain licensure for sub-doctoral folks but wherever this crops up, the State Association affiliated with APA fights it vigorously and gets help in this fight from the Practice Directorate. I currently serve on CAPP which is the oversight board for the Practice Directorate. We have come a long way to establish Psychology as a doctoral profession and there have been seminal events in that history that I would like to mention. The Veterans Administration in 1946 declared that henceforth all Psychologists employed in the VA must be Doctoral and those who held masters degrees were given 5 years to earn their doctorate or leave the VA. I joined the VA in 1951 so I remember those days as many of my friends struggled to get up to speed. That was a most significant move. This was something like the Flexner report in 1925 that Congress adopted, bringing medical education into conformity with national standards. Fly by night medical education was no longer possible. Unfortunately Congress didn’t pay much attention to us and getting control of the educational enterprise was never accomplished nor was it attempted. Psychology departments went about doing whatever they pleased. APA was made to understand it couldn’t dictate to departments of Psychology so they have gotten into line only with the pressures of accreditation at the doctoral level. Here we do have national standards for clinical psychology. I spent 4 years on the APA Accreditation Committee where we wrote the standards for accrediting doctoral programs and internships. But we never achieved what might have been achievable 30 years ago, that is to develop a profession with ladders whereby sub-doctoral folks worked under supervision of doctoral folks and their functions were spelled out. We never built a unified profession that included those below the doctoral degree. It is too late for that now it seems. In 1949 the Boulder conference was held and spelled out the information to which a trained psychologist should have been exposed. They defined the Scientist- Practitioner model that has held sway to this day. Many other national conferences (Vail, Chicago) elaborated on the model and Scholar-Practitioner, Practitioner/Scholar models were developed all of which train within the same general model with more or less emphasis on the Science or Practitioner side. The Professional Schools emerged in the late 60’s and early 70’s where even more emphasis was oriented towards hands on supervision, real clinical work, many hours of patient contact, and completion of an APA approved internship. I was part of a small group of dedicated Practicing Psychologists who created the Rutgers UGSAPP. The first class of students was admitted in 1974. They all came in with masters’ degrees and in 1976 we graduated our first class. Many of them had lots of years of experience prior to coming to Rutgers. Most were simply looking for a credential. But what they learned in 2 years was more than they bargained for. They didn’t know what they didn’t know. The doctoral education that helped put a scientific base on their therapy work. The level of doctoral supervision and the atmosphere of learning with practicing psychologists as teachers in addition to academics was an eye opener for most. When I went to graduate school one didn’t mention that one had eyes for private practice. Psychology has been in an evolving process. Private practice is no longer a dirty word. It has gained respectability but it requires the highest standards because of the responsibility involved. In addition to state laws, which govern the practice and title of psychologist, are numerous significant recognitions that have come into being because of political activity. The US government has placed into law such statutes as Federal Employees Benefits Act (FEBA), Champus, (civilian dependents of armed services personnel), and Medicareall programs in which doctoral Psychologists were added to the list of acceptable professionals . These took many years of negotiating with governmental agencies. In 1968 NJ was the first state to enact Freedom of Choice law which mandated that if a person’s health policy covered a mental condition then a licensed (doctoral) psychologist could be the provider. This could never have been accomplished, nor could any of the federal law changes had we been asking the legislature to recognize psychology at lower than the doctoral level. It wasn’t just a matter of prestige or status. It was necessary to convince legislators that we were responsible, well-trained, ethical, etc. As Psychology continues to evolve and grow it cannot go backward. So what does that mean for the folks studying for a masters degree in Psychology? I understand unofficially, that 1/3 of APAGS go on for doctorates. What do the others do? They enter different professions. They get licensed as marriage and family therapists or as counselors…All well and good. But they don’t become psychologists. If you want to be a Psychologist enter a doctoral program. You will always feel a sense of pride in yourself for getting the best training available. Don’t settle for less. I recall many of my students at Rutgers who were starting families and could not manage a full time internship. I introduced legislation into APA Council of Representatives in support of half time internships and informed all the internships in the country about APA’s position encouraging them to go the extra mile for students who needed an extended period. Again, just as we don’t control the institutions of higher learning, we don’t control the internships but we can exert our influence. Today, we are being corrupted by managed care companies for whom the bottom line is more important than the welfare of patients. They may encourage using less trained personnel. We must fight that. By educating the public to “Talk to Someone Who Can Help” and distributing literature about who a trained doctoral Psychologist is. By lawsuits. By legislation.. The future evolution of Professional Psychology will see us moving more into health care such as Primary care… Psychoneuroimunology… neuropsychology… rehabilitation psychology…. forensic psychology…..feminist psychology…..child and family psychology….. multicultural psychology….. geropsychology….. business and industry consultation….and psychopharmacology…Seriously mentally ill will also receive more services from specially trained psychologists.? The future is attractive.. But I see it as a Doctoral future. Part 2: Tommy T. Stigall A legalistic answer to the question posed by the title of this session, “Is there such a thing as a master’s psychologist?” might be yes, there is such a thing in two states, Vermont and West Virginia. In all other states use of the title “psychologist” with an unrestricted license to practice is legally reserved for persons holding a doctoral degree. In Vermont, two types of license are issued: “Psychologist-Doctorate” and “Psychologist-Master.” There is no difference in the scope of licensure or conditions of practice between the two categories. West Virginia licenses persons as a psychologist on the basis of either a master or doctoral degree in psychology and makes no distinction in functioning or title. Overview of Licensing Laws Reference to the 2002 Handbook of Licensing and Certification Requirements for Psychologists in the United States and Canada (Association of State and Provincial Psychology Boards, 2002) reveals that a number of states regulate the activities of persons with master degrees in psychology by titles other than “psychologist” or with specific limitations imposed on scope or conditions of practice. For example, Kansas recognizes a “Licensed Master’s Level Psychologist” who must be supervised by a Licensed Psychologist or a Licensed Clinical Psychotherapist. Kentucky, Minnesota, and Wyoming license persons with a master degree in psychology as a “Psychological Practitioner.” With 16 graduate hours in psychology beyond the master degree, such license holders in Kentucky may practice independently, although supervision is required in Minnesota and Wyoming. In other jurisdictions, titles such as “Psychological Assistant,” “Psychological Technician,” and “Psychological Examiner” are used for persons with subdoctoral credentials in psychology. Typically, these individuals must workunder the supervision of a Licensed Psychologist with a doctoral degree. They may also be restricted as to work setting and scope of practice. About half the states have a single level of licensure requiring the doctorate. The rest have multi-level licensure. Persons licensed at the master’s level may be permitted to function without supervision but with restrictions on scope of practice or title or both. Thirteen states1 fall into this category. In spite of the fact that a few states now license school psychologists for independent practice based upon a master or specialist degree, the vast majority of school psychologists are credentialed by the state education agency and are limited to working in public or private schools. The question of whether school psychology is a profession in its own right or an area of specialization remains unresolved. APA recognizes school psychology as a specialty of professional psychology for which doctoral education and training is required, while the majority of school psychologists with master degrees tend to identify with the National Association of School Psychologists (NASP) and think of themselves as members of a separate profession. Non-statutory, national certification in school psychology (NCSP) is available for persons who have completed specialist level training (60 graduate semester hours) in school psychology. In a number of states, the NCSP credential is accepted by state education officials for certification as a school psychologist. It is apparent that there is great variability in state licensing laws in spite of the long held APA position requiring “the doctorate as the minimum educational requirement for entry into professional practice as a psychologist” (APA, 1987, p. 698). Thirty-five years ago, the APA Committee on Legislation (1967) advised that “legislation regulating the practice of psychology should be restricted to one level, requiring the doctoral degree…” and that “this level should be designated by the title of ‘psychologist’.” The committee further recommended that “if a state desires legislation below the psychologist level, this level should be designated by a title which includes the adjective ‘psychological’ followed by a noun such as ‘examiner,’ ‘assistant,’ ‘technician,’ etc.…In addition, the law should contain a provision prohibiting independent practice by such individuals” (p. 1099). Clearly, the APA recommendations have had a major impact in shaping state laws. All states provide for licensure of doctorally trained psychologists and, with a few notable exceptions, the title “psychologist” is limited to the doctoral level of licensure. The greatest departure from APA policy has been with regard to multi-level licensure. Defending the Doctoral Standard Pressure on state legislatures to move in the direction of multi-level licensure has come mainly from psychologists with a vested interest in master degree training programs and from the graduates of those programs who desire to engage in independent practice. Given the large numbers of persons graduating each year with master degrees in psychology (Lowe Hays-Thomas, 2000), it is remarkable that so few states have passed laws granting both the title “psychologist” and an unrestricted scope of practice at the master’s level. The Northamerican Association of Masters in Psychology (NAMP) is an organization that seeks to represent persons with master degree training in psychology. NAMP encourages legislative recognition of master’s level psychologists and it “offers certification for masters and doctoral-level psychologists” through its subsidiary Professional Psychologist Certification Board. Information posted on the NAMP website indicates that “there are currently twenty-five states which license masters level psychologists to practice psychology, either independently or under continuing supervision…” (Northamerican Association of Masters in Psychology, n.d.). APA-affiliated state psychological associations are the first line of defense in upholding the doctoral standard for licensure and opposing multi-level licensing laws. Dealing with legislation to license psychologists at the subdoctoral level can be unpleasant, expensive and time consuming. When faced with the introduction of such a bill in the state legislature, there is always the temptation to compromise. Legislators may urge this course of action, since it makes it easier for them not to have to take sides. Proposals to accommodate the needs of master’s level constituents may seem like a small concession to make initially but, having embarked on a course of compromise and appeasement, the ultimate cost may be steep. Over time, a doctoral-level-only law can evolve into a multi-level law and finally into a form that establishes virtual equivalency between doctoral and master’s level licensure. The justification for master’s level credentialing frequently put forward is that there is a flourishing job market for the graduates of master degree programs who are well qualified to work under supervision in public agency settings. The argument is sometimes made that these individuals are at least as well trained and capable as their master’s level counterparts from related fields such as social work and counseling. After surveying recent graduates of four North Carolina master degree programs in psychology and a group of prospective state agency employers, MacKain, Tedeschi, Durham, and Goldman (2002) concluded that “the graduates of our programs initially face a healthy job market in the public sector and have a good reputation for value in the marketplace” (p. 412). They did not find evidence of significant barriers to employment because of the requirement for supervision by a licensed psychologist or limitations on managed care reimbursement. My own experience working in a state mental health system for some 17 years—first as chief psychologist for a community mental health center and later as head of psychology and training for the state Office of Mental Health and Substance Abuse—leads me to a different conclusion. In that setting, except for physicians and psychiatrists who were needed to prescribe and regulate medication, other clinicians were utilized essentially as generic counselors and case managers. Under state law and civil service rules, unlicensed psychological assistants with master degree training were required to have ongoing supervision by a licensed psychologist. Since psychological assistants were not eligible for licensure, and since they had little opportunity for advancement within the system, they quickly became demoralized. Job turnover among this class of employee was high. Those that remained tended to become cynical and malcontent while waiting for the day when they would become eligible for retirement. Supervision was widely-viewed as problematic by all parties concerned. In the course of performing routine and non-challenging duties within an agency setting, assistants came to resent what they cynically referred to as “lifetime supervision.” Supervisors were inclined to treat supervision in a perfunctory manner by “signing off” on the work product of the assistant even when job performance was mediocre. Agency administrators, most of whom were social workers, tended to look upon discipline-based supervision as an unnecessary expense and redundant with administrative supervision. These observations are based upon a much longer timeframe than was employed in the North Carolina survey. I suspect the results of that study would have been considerably different if, instead of surveying only newly-employed recent graduates and prospective employers, the researchers had sampled the opinions of public agency administrators and employees over a period of several years. The authors acknowledge that “these surveys do not address any long-term implications of rules governing master’s level training and licensure and the potential impact of these rules on future professional development and satisfaction” (MacKain, Tedeschi, Durham, & Goldman, 2002, p. 412). My conclusions about the impact of managed care on the career opportunities of persons trained with master degrees in psychology is also at variance with that of the North Carolina researchers. The National Committee on Quality Assurance (NCQA) is the industry-recognized, standard-setting body for accreditation of managed behavioral health organizations (MBHOs). Compliance with NCQA standards requires the MBHO to document its credentialing and recredentialing mechanisms for psychologists and other health care practitioners and to verify state licensure for independent practice at the highest level recognized by the state (National Committee for Quality Assurance, 1999). This standard creates a formidable barrier for persons holding master degrees in psychology who might wish to qualify as individual providers on managed care panels. One solution to this problem might be to become licensed in a discipline other than psychology that does not require a doctoral degree for independent practice. In a number of states, master’s level licensure is available as a mental health counselor, marriage and family therapist, or licensed psychotherapist. But this is likely to be a time-limited option, as other occupations define more narrowly their education and training requirements for licensure. Supply and Demand Considerations Recent attention within organized psychology to issues of workforce supply and demand (American Psychological Association and Association of Psychology Postdoctoral and Internship Centers, 1999; Farberman, 2000) has not settled the question of the proper role and credential for persons with master degrees in psychology. Robiner and Crew (2000) have examined trends in the training of mental health professionals, data from state psychology licensing boards, and various assumptions about societal need for behavioral health services. They argue persuasively for downsizing the psychological workforce in the face of current marketplace trends, including the restraining influence of managed care. Survey data from licensing boards reveal that in 1995 6.5% of licensed psychologists in the United States were master’s level practitioners. A similar number of persons with master degrees held some form of limited license. The combined total of 11,445 master degree licensees accounted for 12% of the 95,104 licensed workforce (Robiner & Crew, 2000, p. 248). Using various estimates of the number of psychologists needed in a managed care environment, Robiner and Crew projected a surplus of 27,949 psychologists, exceeding by 45.4% the number needed in the 1995 workforce. This was under the most optimistic set of assumptions employed in their projections. “Analysis by state revealed regional variation and a mean of 31.7 licensed psychologists/100,000 population and a median of 27.7/100,000, ranging from 10.3 psychologists/100,000 in Louisiana to 85.2 psychologists/100,000 for Vermont (where 39% of psychologists are master’s level)” (Robiner & Crew, 2000, p. 251). Continued production of large numbers of master’s level providers can only aggravate the worsening employment prospects for all psychologists. In an increasingly competitive job market, licensed doctoral psychologists are more likely to accept positions in the public service sector that previously would have been filled by master’s level providers. Cannibalization of doctoral positions by master’s level job-seekers is another possible, but less likely, scenario. Summary and Conclusions
References American Psychological Association. (1987). Model act for state licensure of psychologists. American Psychologist, 42, 696-703. American Psychological Association and Association of Psychology Postdoctoral and Internship Centers. (1999). Proceedings from the National Working Conference on Supply and Demand: Training and employment opportunities in professional psychology. Washington, DC: Authors. APA Committee on Legislation. (1967). A model for state legislation affecting the practice of psychology 1967: Report of the APA Committee on Legislation. American Psychologist, 22, 1095-1103. Association of State and Provincial Psychology Boards. (2002). 2002 Handbook of Licensing and Certification Requirements for Psychologists in the United States and Canada. Montgomery, AL: Author. Farberman, R. K. (2000, September). When is a new psychologist ready for independent practice? Monitor on Psychology, 31, 44-47. Lowe Hays-Thomas, R. (2000). The silent conversation: Talking about the master’s degree. Professional Psychology: Research and Practice, 31, 339-345. MacKain, S. J., Tedeschi, R. G., Durham, T. W., & Goldman, V. J. (2002). So what are master’s- level psychology practitioners doing? Surveys of employers and recent graduates in North Carolina. Professional Psychology: Research and Practice, 33, 408-412. National Committee for Quality Assurance. (1999). Standards and surveyor guidelines for the accreditation of MBHOs. Washington, DC: Author (Footnotes) 1 Alabama (Psychological Technician), Alaska (Psychological Associate), Arkansas (Psychological Examiner), Kansas (Licensed Clinical Psychotherapist), Maine (Psychological Examiner), North Carolina (Licensed Psychological Associate), Ohio (School Psychologist), Oregon (Psychologist Associate–Independent), Tennessee (Psychological Examiner), Texas (Licensed Specialist in School Psychology), Virginia (School Psychologist), West Virginia (School Psychologist), and Wisconsin (Private Practice School Psychologist). |
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