This is a time of both crisis and great opportunity for psychologists and psychology. The managed care juggernaut has striped much of our autonomy and decision making power. Now, lesser trained utilization review personnel make important treatment decisions that impact on the care we provide our patients. Rather than clinically appropriate treatment decisions based on each patient’s particular needs, many of these decisions are fiscally motivated and based on arbitrary cost containment guidelines.

Psychologists are receiving less money for the services they provide and patients often receive less care than they need. Managed care frequently uses the ephemeral standard of ‘medical necessity’ as a rationale for withholding much needed treatment services. Managed care policies have intruded into the psychologist-patient relationship in ways that have affected both the sanctity of patient-psychologist privacy and their ability to determine the appropriate course of treatment together.

Both within and outside of managed care psychologists must compete with Masters level or even Bachelors level clinicians who will treat patients for much lower fees. The premiums paid to the insurer remain the same regardless of who provides the treatment. Thus, managed care organizations are motivated to delay, restrict, and even withhold treatment and to have it provided by the lowest bidder, not by the one who can provide the best treatment. Many graduate schools are producing large numbers of Masters level mental health clinicians who in a number of states may now practice independently. The competition we face is fierce. This situation has demoralized many and has created a state of pessimism and passivity for some; perhaps for you.

Now that I have your attention I will tell you why pessimism and passivity are not in order. Psychologists are in an excellent position to take advantage of this situation. Our training provides us with a unique set of skills that no other groups of mental health professionals possess. These skills will enable us not only to survive, both individually and as a profession, but to thrive.

Many psychologists are utilizing their training in research methodology to conduct outcome studies which demonstrate the greater effectiveness of many of the treatments we provide. Others are developing areas of specialization that lesser trained clinicians can not effectively function in and which are free of managed care and its effects. This includes areas of practice such as neuropsychology, forensic psychology to include conducting child custody evaluations, child psychology to include ADHD and LD evaluations and treatment of a wide variety of disorders the treatment of eating disorders, and a variety of other areas of practice. Psychologists are also developing practice niches such as consulting with businesses, providing treatment to divorcing families and assisting with other life transitions, treating medical disorders with a psychological component such as migraines, hypertension, and irritable bowel syndrome, providing psychological treatment to cancer victims, providing physicians with psychopharmacology consultations, doing coaching and mediation, working with special populations such as the elderly, working with couples suffering from infertility, providing smoking cessation and weight loss services, assisting step and other blended families, and working with victims of violence . Others will develop innovative means of providing their services such as directly from physicians’ offices as part of a comprehensive health care delivery system or from the courts providing pre and post divorce counseling and mediation services. This list is not exhaustive, but it highlights many of the innovative and creative ways psychologists are utilizing their training and skills.

Possessing good training and skills is not enough in today’s health care market place. Psychologists must realize that one of the keys to success is marketing. The time is long past for taking out an advertisement in the Yellow Pages and waiting for the phone to ring off the hook. Successful psychologists are now entrepreneurs. They utilize business skills such as in marketing and practice management. They know how to market their services directly to businesses, referral sources, and consumers. Our clinical skills are no longer enough. In addition to a solid well-rounded education in psychology, graduate students should consider taking at least one course in business. Developing relationships with successful psychologists outside of your graduate school is important as well. Seek out mentors who can serve as role models and who will assist you in making needed connections for when you enter practice. While there is no substitute for clinical competence, one should not underestimate the importance of networking opportunities in the professional community a good mentor can provide us with.

Psychologists must also have a vision of the future of our profession and livelihood that incorporates a proactive approach. Whether it includes psychopharmacology training and prescriptive authority, marketing our services directly to employers, demonstrating treatment efficacy through outcome studies, or practice in any of the niches described earlier, successful psychologists are expanding the scope of skills used and services provided. Being a generic psychotherapist is no longer enough.

Successful psychologists are also able to see the big picture and understand the importance of influencing larger systems. We must see that our own passivity and apathy are our greatest enemies. We must educate legislators, serve as resources to them on mental health issues, and establish ongoing relationships with them. Merely lobbying them on selected issues that serve our best interests is not enough. Legislative advocacy must be included as a part of our professional identity and of our weekly schedule. We must also get involved in and support the work of our professional associations. This is one place where we really can make a difference. Get involved in your State Psychological Association and APA. Join a committee or board. Just get involved! This way you can shape your own future, rather than leave this task to others who are motivated by their own needs and interests.

Some will cling to outdated models of professional practice or be passive and apathetic, hoping others will somehow make things better. No one else will do it. It’s on our shoulders. Those who take on this role of advocacy, action, and expanded professional practice will not only survive, but will thrive and succeed in this time of great opportunity. Utilizing our training, developing specialized skills and demonstrating their value, actively marketing our services, and working to influence the system legislatively, seeking out mentoring relationships with successful entrepreneur psychologists, and educating the public we serve, will all help us to achieve this goal.

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