You give me too much credit (but I'll take it). It's relatively easy to get good at something when it is all you do, but I am still mindful of "drift" and make sure to regularly review my work with colleagues, as well as question my regular referral sources (generally early intervention providers who i'm fortunate to have present at during the assessments) as to the how they feel I'm doing. Oh yeah- and I stay up on the literature, which is made easier to do by my secondary gig as an adjunct faculty.
As to being in a "key leadership" role, I've worked for places where having psychologists in control is a great things, and others where it did not work out so well. To some extent- obviously- it depends on the individuals. My current agency is has psychologists in all key senior leadership roles (including the owner). The missions is of the agency as a whole and of my small part of it are very clear, and we are expected to deliver mission focused services in a way that also keeps the lights on. If we do that, we have a lot of autonomy and control over what we do (and are reinforced for doing so). It works very well for me.
I've came from a primarily administrative/senior leadership background (my last job was actually primarily admin as a director of operations for an agency, and previously I've directed private special education schools). I'm VERY happy not to be doing that kind of thing anymore. It's a lot of really difficlut decision making, and you can't expect to make everyone happy (but you should still try to maximize the happiness). My current job is my first pure clinical position since practica. I'm very cautious about offering administrative/bigger policy decisions unless asked, as I'm aware that the people higher up usually have access to a lot more information than I do (and I trust them to do a good job and ask me for my opinion if they want it.
I've been thinking more about the original topic of this thread. Over the past few years I've had several non-psychologist colleagues (e.g., direct care ABA providers, early intervention developmental specialists) talk to me about pursuing graduate training so that they can "do what I do." So far they have all ended up going into a masters level graduate program (either ABA or Speech Therapy). The primary reason is that they can do so without having to uproot their lives and move accross country. The secondary reason is, realistically, they would not be competitive for a funded program and I advise them against the somewhat local PsyD program and it's exhorbitant cost. Even if they did start the Ph.D. process now, it'd be YEARS before they could help address the current problem. The only solution is really to attract already credentialled psychologist to this area of practice.
It's kind of a shame- these are young people who are motivated to adress this problem of access to diagnosis, have a proclivity for working with this population, and seem to be-in most cases- reasonably intelligent. I do think that I am not a great example for them of what a clinical psychologist is trained to do, as they only see me doing the exact same thing every time (which is a VERY small portion of what I'm actually trained, qualified, and credentialled to do). I don't like the idea of watering down the training (i.e, masters level ASD diagnosticiean) to just focus on ASD diagnosis, as this would also "water down" remibursement rates. However, we are kind of at the state of a public health emergency and the needs of these children and families outweighs the needs of me and the one or two other psychologist in the four-county-area to make a better living.
