Why do so few psychologists offer clinical assessments

[taylortaylor164]

Just something that I have noticed lately. I live in a medium-sized city on the east coast, and yet I still feel as though there are fewer than 10 psychologists in the city who offer psychodiagnostic or psychoeducation assessments. Granted, this is amongst private practice practitioners, as many of those employed in hospitals are probably neuropsychologists, or focus on specific medical populations. Why do so many not wish to offer assessments? Is it risk of litigation or going to court?

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[Therapist4Chnge]

Commercial insurance rarely pays for psychological assessment. If they do pay for it, they limit hours and often make the clinician jump through hoops before even authorizing it. One advantage to being credentialed on the medical side (as opposed to behavioral health) is the clinician can avoid some of the add hoops on the behavioral health side. They shouldn't be treated differently (Parity law), but they are definitely treated differently.

 

[BuckeyeLove]

Most of your psycho-ed stuff is done by school psychologists working for districts right? That tends to be who i see doing them when I am doing forensic work with kiddos. As it pertains to psycho-diagnostic...in my experience that comes down to why and what is being asked/and more importantly what the assessment is potentially going to be used for. This is where specialization is important (i.e., custody, assessment of capacities related to a psycho-legal question, medico-legal, etc.). Most people don't really want and/or need a full psycho-diagnostic assessment to help with aiding in therapy. Kiddos is a bit of a different ballgame though.

 

[taylortaylor164]

Commercial insurance rarely pays for psychological assessment. If they do pay for it, they limit hours and often make the clinician jump through hoops before even authorizing it. One advantage to being credentialed on the medical side (as opposed to behavioral health) is the clinician can avoid some of the add hoops on the behavioral health side. They shouldn't be treated differently (Parity law), but they are definitely treated differently.

Many of testing psychologists around here are out of pocket, yes. They still appear to maintain long waitlists despite this.

 

[taylortaylor164]

Most of your psycho-ed stuff is done by school psychologists working for districts right? That tends to be who i see doing them when I am doing forensic work with kiddos. As it pertains to psycho-diagnostic...in my experience that comes down to why and what is being asked/and more importantly what the assessment is potentially going to be used for. This is where specialization is important (i.e., custody, assessment of capacities related to a psycho-legal question, medico-legal, etc.). Most people don't really want and/or need a full psycho-diagnostic assessment to help with aiding in therapy. Kiddos is a bit of a different ballgame though.

Being on the adult side, I do think there is a higher need for pediatric assessments. Though at the clinic I am currently at, there is a pretty constant stream of adult folks asking for assessments for like ADHD, sometimes Autism, or whether anxiety/depression is impacting cognitive functioning.

 

[WisNeuro]

Being on the adult side, I do think there is a higher need for pediatric assessments. Though at the clinic I am currently at, there is a pretty constant stream of adult folks asking for assessments for like ADHD, sometimes Autism, or whether anxiety/depression is impacting cognitive functioning.

This one is easy, objectively, it's not.

 

[Therapist4Chnge]

Many of testing psychologists around here are out of pocket, yes. They still appear to maintain long waitlists despite this.

I'm out of the loop in regard to what is being taught in training programs these days, but it seems that a lot of students coming out aren't as interested in formal assessment. Diagnostic skills, differential diagnosis, and assessment should be pillars of clinical training. Has anyone else seen this?

A lot of the <18 assessment is connected to school assessment, which can both take awhile and also be pretty specific to the setting. School psychologists are doing the majority of them. The higher acuity cases should be handled by pediatric neuropsychologists, but they are few and far between. Reimbursements can be an issue for everything but private pay, so it's a tough argument to try and find specialists to take medicaid level rates for reimbursement when the materials for the testing are often a large % of the reimbursement being paid. I know this recently came up on a list serv I'm on. I know locally there is a big need, but it's not worth the hassle and incredibly low reimbursements being offered by the state/court systems.

Formal testing for autism can easily have a 1 yr wait list, or so I've been told. There are not many pediatric assessment people in general, but even less that do autism evals, custody related evals, and court-ordered evals. Those are three very very different areas of assessment, and often they can have poor reimbursements associated with them, so it is hard to find practitioners to take those cases. I get calls every once in awhile from the court trying to get me to do some court-ordered evals, but the pay is beyond bad, and they tend to be messy cases. There was a local clinician who did those evals for years, but they recently retired, so the backlog grows. If reimbursements were doubled/tripled, then they could probably get more providers to see the school, community, and court referrals but thus far there have been no attempts to raise reimbursements.

 

[Sanman]

This one is easy, objectively, it's not.

More likely the opposite.

 

[AcronymAllergy]

I'm out of the loop in regard to what is being taught in training programs these days, but it seems that a lot of students coming out aren't as interested in formal assessment. Diagnostic skills, differential diagnosis, and assessment should be pillars of clinical training. Has anyone else seen this?

A lot of the <18 assessment is connected to school assessment, which can both take awhile and also be pretty specific to the setting. School psychologists are doing the majority of them. The higher acuity cases should be handled by pediatric neuropsychologists, but they are few and far between. Reimbursements can be an issue for everything but private pay, so it's a tough argument to try and find specialists to take medicaid level rates for reimbursement when the materials for the testing are often a large % of the reimbursement being paid. I know this recently came up on a list serv I'm on. I know locally there is a big need, but it's not worth the hassle and incredibly low reimbursements being offered by the state/court systems.

Formal testing for autism can easily have a 1 yr wait list, or so I've been told. There are not many pediatric assessment people in general, but even less that do autism evals, custody related evals, and court-ordered evals. Those are three very very different areas of assessment, and often they can have poor reimbursements associated with them, so it is hard to find practitioners to take those cases. I get calls every once in awhile from the court trying to get me to do some court-ordered evals, but the pay is beyond bad, and they tend to be messy cases. There was a local clinician who did those evals for years, but they recently retired, so the backlog grows. If reimbursements were doubled/tripled, then they could probably get more providers to see the school, community, and court referrals but thus far there have been no attempts to raise reimbursements.

In my experience, it hasn't so much been that trainees are less interested in assessment. It's more that their programs aren't offering as much instruction and/or clinical training in it, and they seem to have a shortage of psychologists able to supervise.

At least in PP, besides the insurance piece, it can be a bit cost-prohibitive to purchase all the tests typically included in a standard psychoed unless you're doing lots of them. And often, PP schedules are already overbooked with non-psychoed assessments. Also, parents (even of college-aged students) can be a pain, especially if they're paying thousands of dollars for an eval and don't get the diagnosis they're wanting.

Beyond that, again in my experience, it's just that there aren't as many psychologists who are as comfortable with assessment. Although in PP, you'll also see psychologists who are overly confident in their assessment competence.

 

[MCParent]

I don’t think almost anyone enters grad school aiming to do assessments. The overwhelming majority of folks are interested in doing therapy and/or research. It can be hard to grasp what assessment is in undergrad, whereas almost everyone has some understanding of therapy (even if it’s informed by movies and mistaken!) and some sense of what research is. I had an assessment pp and I like doing assessment, but I didn’t know what assessment was until grad school. If you don’t have a strong instructor in your grad class on assessment, its hard for me to see how folks would develop a strong passion for it.

 

[WisNeuro]

I don’t think almost anyone enters grad school aiming to do assessments. The overwhelming majority of folks are interested in doing therapy and/or research. It can be hard to grasp what assessment is in undergrad, whereas almost everyone has some understanding of therapy (even if it’s informed by movies and mistaken!) and some sense of what research is. I had an assessment pp and I like doing assessment, but I didn’t know what assessment was until grad school. If you don’t have a strong instructor in your grad class on assessment, its hard for me to see how folks would develop a strong passion for it.

For many, yeah. But, there are a decent number of us who worked in neuro labs in undergrad and administered test batteries. I definitely had about 500 testing hours before even getting into grad school.

 

[The Cinnabon]

I don’t think almost anyone enters grad school aiming to do assessments. The overwhelming majority of folks are interested in doing therapy and/or research. It can be hard to grasp what assessment is in undergrad, whereas almost everyone has some understanding of therapy (even if it’s informed by movies and mistaken!) and some sense of what research is. I had an assessment pp and I like doing assessment, but I didn’t know what assessment was until grad school. If you don’t have a strong instructor in your grad class on assessment, its hard for me to see how folks would develop a strong passion for it.

As crass as this sounds, as the post-bac peon that does a decent amount of testing (for a peon) for research purposes, something I've found that I quite like is that I can have pretty deep conversations with clients but not really have any onus to treat them in any capacity. For the larger study I'm on right now if I have someone pretty difficult I know they won't really be my problem after 2-4 hours or w/e. I don't believe these perks will be remain true in a psychotherapy context.

 

[quickpsych]

I think a few factors and possibilities:

- As others said, many want to do therapy, not assessment. However, a caveat to another comment on here about programs teaching assessment, it is a requirement for APA accredited programs so everyone should be getting at least some assessment training, instruction, and face to face assessment work in any reputable grad program. So it's more interest not lack of inclusion of the training.

- You might spend 3-5 hours, maybe little more with a client doing the testing, then it's hours of scoring, interpreting data, and writing. I've had years of training in various assessment settings and it wasn't uncommon to see a full time psychologist focused on assessment maybe doing face to face work a 1-2 days a week and rest was scoring/interpreting/writing/backend stuff. I imagine many who go into this field want to "be in the thick of it" not behind a computer screen typing.

- The issue of school 'psychologists.' I remember mid 2010s there was a big thing in multiple states of psychologist professional organizations pushing to reclassify school psychologists who, aren't, in fact usually actual psychologists. But education unions and the school systems have quite powerful lobbying as well, so not sure what came of that. My points with this:, Firstly, there's a lot of subpar assessments out there by these school "psychologists" because their training is limited. They're basically masters level assessment clinicians with a focus on academic testing. Secondly, I'm sure some schools and supervisors see these other clinicians as boogeymen in the field and discourage those becoming actual psychologists from doing assessment (i.e. the school ones are often cheap, subsidized, or free as they often work for school districts and how can we ever compete oh no!).

- Cost of maintaining test materials, supplies, office space, as well as factoring in how much you charge vs how many hours it takes you to do everything you need from start to finish for an assessment. I'm sure some don't want to spend hours on the back end stuff for each assessment.

I enjoy both therapy and assessment and even though may main current gig is more niche in medical settings , I keep up a very schedule limited per diem with a small boutique private practice to scratch the assessment and traditional therapy itch.

 

[WisNeuro]

I think a few factors and possibilities:

- As others said, many want to do therapy, not assessment. However, a caveat to another comment on here about programs teaching assessment, it is a requirement for APA accredited programs so everyone should be getting at least some assessment training, instruction, and face to face assessment work in any reputable grad program. So it's more interest not lack of inclusion of the training.

- You might spend 3-5 hours, maybe little more with a client doing the testing, then it's hours of scoring, interpreting data, and writing. I've had years of training in various assessment settings and it wasn't uncommon to see a full time psychologist focused on assessment maybe doing face to face work a 1-2 days a week and rest was scoring/interpreting/writing/backend stuff. I imagine many who go into this field want to "be in the thick of it" not behind a computer screen typing.

- The issue of school 'psychologists.' I remember mid 2010s there was a big thing in multiple states of psychologist professional organizations pushing to reclassify school psychologists who, aren't, in fact usually actual psychologists. But education unions and the school systems have quite powerful lobbying as well, so not sure what came of that. My points with this:, Firstly, there's a lot of subpar assessments out there by these school "psychologists" because their training is limited. They're basically masters level assessment clinicians with a focus on academic testing. Secondly, I'm sure some schools and supervisors see these other clinicians as boogeymen in the field and discourage those becoming actual psychologists from doing assessment (i.e. the school ones are often cheap, subsidized, or free as they often work for school districts and how can we ever compete oh no!).

- Cost of maintaining test materials, supplies, office space, as well as factoring in how much you charge vs how many hours it takes you to do everything you need from start to finish for an assessment. I'm sure some don't want to spend hours on the back end stuff for each assessment.

It's all billable. Especially at the nice high forensic rates I, for one, love extensive record review.

 

[quickpsych]

It's all billable. Especially at the nice high forensic rates I, for one, love extensive record review.

You'd be surprised, or maybe not, how many psychologists especially in PP don't charge for record reviews (like the per page after X pages) because of <insert some reason ranging from customer service to optics to feeling bad charging>. Or ones who do consults or school meetings without extra charge "because we include it as a portion of the testing fee."

Maybe it's just because they're charging the person or parent and not insurance , but I'm an advocate of setting boundaries and laying out the fees and cost. I've seen some just get walked all over doing essentially free work on top because they don't bill when they can bill.

 

[PsyDr]

It's all billable. Especially at the nice high forensic rates I, for one, love extensive record review.

Uhhh… I’ve been encouraging everyone to do that for over a decade.

 

[Sanman]

In my experience, it hasn't so much been that trainees are less interested in assessment. It's more that their programs aren't offering as much instruction and/or clinical training in it, and they seem to have a shortage of psychologists able to supervise.

At least in PP, besides the insurance piece, it can be a bit cost-prohibitive to purchase all the tests typically included in a standard psychoed unless you're doing lots of them. And often, PP schedules are already overbooked with non-psychoed assessments. Also, parents (even of college-aged students) can be a pain, especially if they're paying thousands of dollars for an eval and don't get the diagnosis they're wanting.

Beyond that, again in my experience, it's just that there aren't as many psychologists who are as comfortable with assessment. Although in PP, you'll also see psychologists who are overly confident in their assessment competence.

The cost prohibitive piece is a big thing. Unless you are full time neuropsych, it is hard to justify the investment. With telehealth, therapy is becoming even more appealing than a traditional practice with additional costs for assessment.

The other thing I will say is that a lot the assessment I see being taught has little to do with what is in demand in pp. I don't know anywhere outside the VA that does regular personality assessments. Yet, I had to seek out specialty rotations that exposed me to ADHD, pre-surgical, or psycho-ed assessments. Even with peds and adult neuropsych experience, I didn't have much exposure to autism assessments. Most of the grads today have much less exposure than I did and a lot of the training rotations are not real world (PP) relevant. Yet they still learn the Rorschach.

 

[ThatsPsi4U]

Just something that I have noticed lately. I live in a medium-sized city on the east coast, and yet I still feel as though there are fewer than 10 psychologists in the city who offer psychodiagnostic or psychoeducation assessments. Granted, this is amongst private practice practitioners, as many of those employed in hospitals are probably neuropsychologists or focus on specific medical populations. Why do so many not wish to offer assessments? Is it risk of litigation or going to court?

Time commitment and cost of testing materials perhaps...I dunno...just a quip guess.

 

[cara susanna]

The cost prohibitive piece is a big thing. Unless you are full time neuropsych, it is hard to justify the investment. With telehealth, therapy is becoming even more appealing than a traditional practice with additional costs for assessment.

The other thing I will say is that a lot the assessment I see being taught has little to do with what is in demand in pp. I don't know anywhere outside the VA that does regular personality assessments. Yet, I had to seek out specialty rotations that exposed me to ADHD, pre-surgical, or psycho-ed assessments. Even with peds and adult neuropsych experience, I didn't have much exposure to autism assessments. Most of the grads today have much less exposure than I did and a lot of the training rotations are not real world (PP) relevant. Yet they still learn the Rorschach.

I think that psych testing is really misunderstood in the VA. People think it will solve everything, lol.

 

[PsyDr]

Since CPT reimbursement is partially determined by overhead costs, Telehealth will kill our profession.

Our outpatient codes already say we are worth less because we don’t require nurses. Wait until they argue that we don’t even need offices.

 

[Sanman]

Since CPT reimbursement is partially determined by overhead costs, Telehealth will kill our profession.

Our outpatient codes already say we are worth less because we don’t require nurses. Wait until they argue that we don’t even need offices.

Curious to see if there will be an added originating site payment for a hospital or clinic vs provider at working from home.

 

[PsyDr]

Curious to see if there will be an added originating site payment for a hospital or clinic vs provider at working from home.

There's been a LOT of discussion about that. Hospitals have been billing telemedicine services as if the services are being provided in the facility.

‘The Charges Seem Crazy’: Hospitals Impose a ‘Facility Fee’ — For a Video Visit - KFF Health News

Facility fees, designed to help hospitals cover the high cost of staying open 24/7, have long rankled consumers. Now, some patients are assessed the fees while sitting at home for a telehealth appointment.

kffhealthnews.org

 

[Therapist4Chnge]

“Facility Fees” have always been a scam. Theoretically hospital square footage could be more expensive, but to take it on to everything is just padding the bottom line.

Psychologists continue to shoot our selves in the foot. We gave up access to E&M codes, allowed midlevels to proliferate and lobby better than us, and spend so much time in-fighting that our reimbursements have suffered bc we can rarely agree on anything.

 

[Sanman]

Psychologists continue to shoot our selves in the foot. We gave up access to E&M codes, allowed midlevels to proliferate and lobby better than us, and spend so much time in-fighting that our reimbursements have suffered bc we can rarely agree on anything.

It is a much larger than just shooting ourselves in the foot. The field often considers practitioners second class citizens. While those that consider themselves "better" are so busy patting themselves on the back that they don't accomplish anything of relevance to the majority of the guild. The fact that I can hear all about the pop culture cause of the day but can't get useful CPT clarifications from the APA website tells what I need to know about priorities.

 

[bcliff]

For many, yeah. But, there are a decent number of us who worked in neuro labs in undergrad and administered test batteries. I definitely had about 500 testing hours before even getting into grad school.

Same.

 

[bcliff]

More likely the opposite.

More likely anxiously catastrophizing normal cognitive variability.

 

[WisNeuro]

It is a much larger than just shooting ourselves in the foot. The field often considers practitioners second class citizens. While those that consider themselves "better" are so busy patting themselves on the back that they don't accomplish anything of relevance to the majority of the guild. The fact that I can hear all about the pop culture cause of the day but can't get useful CPT clarifications from the APA website tells what I need to know about priorities.

While there is some guild/reimbursement work still going on at federal/state levels, there is definitely a shift of resources and messaging away from it. And that, in turn, trickles down to people actually giving a **** and doing anything at the grassroots level. I mean, look at the dismal response to CMS comment periods and issues related to reimbursements. It's a 5-10% hit rate on a good day. There's a reason that all of our clinical service reimbursements are sliding down to match midlevels from payor sources. Glad to not be an early career person in this field.

 

[Sanman]

More likely anxiously catastrophizing normal cognitive variability.

In some cases. However, I have treated plenty of folks where mild neurocognitive disorder (and particularly executive dysfunction) has led to increased anxiety and depression due to difficulties completing IADLs (handling finances, handling medications, etc).

 

[bcliff]

In some cases. However, I have treated plenty of folks where mild neurocognitive disorder (and particularly executive dysfunction) has led to increased anxiety and depression due to difficulties completing IADLs (handling finances, handling medications, etc).

I would say "in most cases," assuming they don't have a neurologic history and / or aren't over the age of 65. Even among 60-somethings dementia base rates are still super low.

 

[Sanman]

I would say "in most cases," assuming they don't have a neurologic history and / or aren't over the age of 65. Even among 60-somethings dementia base rates are still super low.

You're talking to a geropsychologist. My clients are currently between 62 and 102. Not thinking about general outpatient.

 

[WisNeuro]

You're talking to a geropsychologist. My clients are currently between 62 and 102. Not thinking about general outpatient.

Def a base rates thing. In the <70 crowd, dementia incidence is low single percentage points. But, as you point to, the patients coming to see me, and presumably you to some extent, have a much higher rate of dementia than the general pop. My referral sources have usually screened out the obvious "nothing is wrong" patients so my "worried well" patients are reduced, but still there.

 

[Sanman]

Def a base rates thing. In the <70 crowd, dementia incidence is low single percentage points. But, as you point to, the patients coming to see me, and presumably you to some extent, have a much higher rate of dementia than the general pop. My referral sources have usually screened out the obvious "nothing is wrong" patients so my "worried well" patients are reduced, but still there.

It is a base rate issue. The median age on my roster is 75, if not closer to 80. Yesterday's intake was 91 (and tangential as hell).

 

[texanpsychdoc]

I offer testing in my practice, but I haven't taken on any testing clients because it is not worth the time and jumping through the hurdles to do testing with the insurances Im paneled with. I actually make more in one hour doing therapy than I would doing testing plus any scoring, report writing, etc. I also don't take couples who have insurance for the same reason as a 90847 makes me lose $47 to $53 of my income in that hour compared to if I saw an individual for 53 minutes and billed a 90837.

To give you an idea of what I am reimbursed with my insurances....I make roughly $190 for a one hour 90791 and anywhere between $147 to $153 for a 90837. I need every slot I have available to be maximized to its fullest potential.

 

[Sanman]

I offer testing in my practice, but I haven't taken on any testing clients because it is not worth the time and jumping through the hurdles to do testing with the insurances Im paneled with. I actually make more in one hour doing therapy than I would doing testing plus any scoring, report writing, etc. I also don't take couples who have insurance for the same reason as a 90847 makes me lose $47 to $53 of my income in that hour compared to if I saw an individual for 53 minutes and billed a 90837.

To give you an idea of what I am reimbursed with my insurances....I make roughly $190 for a one hour 90791 and anywhere between $147 to $153 for a 90837. I need every slot I have available to be maximized to its fullest potential.

Any pushback on billing 90837 vs 90834 for insurance folks?

 

[texanpsychdoc]

Any pushback on billing 90837 vs 90834 for insurance folks?

Nope. I have been billing 90837 for every single patient (I see about 20-25 a week) since April and have not heard a peep. Actually, the opposite. United gave me about a $27 rate increase last month.

 

[Freud’sMommy]

It's because no one likes hunting down teacher rating scales a week or two after the report could've been finalized... Ok, maybe that's just me?

 

[Sanman]

It's because no one likes hunting down teacher rating scales a week or two after the report could've been finalized... Ok, maybe that's just me?

No that is quite annoying. Working with caregivers, parents, teachers, etc is always an additional (uncompensated) headache.

 

[texanpsychdoc]

No that is quite annoying. Working with caregivers, parents, teachers, etc is always an additional (uncompensated) headache.

It's why I don't work with kids or teens. On the rare occasions I get "adult children" where the parent is basically coordinating everything for their child to see me, I set firm boundaries and reinforce that they cannot pester me or think they have unlimited access to their child's information unless their child permits me to do so since they are 18+. I generally screen people out who call me saying they are calling on behalf of someone else....that's a whole potential mess I'd rather avoid in the first place. Plenty of other providers out there I am sure who are good with working with folks like this....just not me. I have plenty of people knocking on my door for referrals.

 

[WisNeuro]

There's a reason many of us go into forensics, I bill for EVERYTHING. Lawyer wants a quick phone consult, on the clock. Want me to write an addendum based on new info, on the clock. Want me to wade through 3k+ records? Cha ching!

 

[Sanman]

It's why I don't work with kids or teens. On the rare occasions I get "adult children" where the parent is basically coordinating everything for their child to see me, I set firm boundaries and reinforce that they cannot pester me or think they have unlimited access to their child's information unless their child permits me to do so since they are 18+. I generally screen people out who call me saying they are calling on behalf of someone else....that's a whole potential mess I'd rather avoid in the first place. Plenty of other providers out there I am sure who are good with working with folks like this....just not me. I have plenty of people knocking on my door for referrals.

Honestly, pretty smart and that is coming from someone that speaks to caregivers all day.

 

[WisNeuro]

Honestly, pretty smart and that is coming from someone that speaks to caregivers all day.

On the clinical side, I strongly encourage patients to bring in a close friend family member, in cases where possible for feedback. Gets rolled into 96132/133.

 

[Sanman]

On the clinical side, I strongly encourage patients to bring in a close friend family member, in cases where possible for feedback. Gets rolled into 96132/133.

Definitely, there are times when it is necessary. Unfortunately, the psychotherapy/ codes are no longer nearly as flexible and behavioral management was nonexistent other than billing family therapy.

 

[Therapist4Chnge]

There's a reason many of us go into forensics, I bill for EVERYTHING. Lawyer wants a quick phone consult, on the clock. Want me to write an addendum based on new info, on the clock. Want me to wade through 3k+ records? Cha ching!

So. Much. This.

While last minute work can blow up a weekend and/or cause me to have to re-arrange my time, I’m billing every minute *and* a rush fee.

I had two addendums pop up in the past 2 weeks, so I had to move some clinical work around, but the addendums and rush fees covered my overhead (including my salary) for Oct. Now I won’t feel bad scheduling a beach getaway towards the end of the month.

 

[Sanman]

So. Much. This.

While last minute work can blow up a weekend and/or cause me to have to re-arrange my time, I’m billing every minute *and* a rush fee.

I had two addendums pop up in the past 2 weeks, so I had to move some clinical work around, but the addendums and rush fees covered my overhead (including my salary) for Oct. Now I won’t feel bad scheduling a beach getaway towards the end of the month.

Looking at it from a larger lens, what does it say about our society when healthcare providers have to move into the legal arena for decent compensation and work/life balance?

 

[Freud’sMommy]

Looking at it from a larger lens, what does it say about our society when healthcare providers have to move into the legal arena for decent compensation and work/life balance?

I can't make claims about society at large, but it partially says that psychologists, especially pediatric psychologists, are too agreeable and amenable to extra work whereas forensically minded folks, not unlike lawyers, tend to be more disagreeable and therefore more comfortable asking for such things. A few months ago one of the psychologists on our faculty suggested that we should start charging small fees for communications/extra forms unrelated to the main assessment and everyone shut him down. Said it's "not right," and that it's "part of the care." The specific example was filling out a government form for some tangential service.

 

[Therapist4Chnge]

That kind of paperwork can eat up HOURS depending on the type and what they need. I haven’t taken commercial insurance in years, but I used to have the patient come in for a f/u and I’d use that time to fill out the paperwork. Many FP/PCP clinicians do it this way bc otherwise they’d work even more uncompensated hours.

 

[texanpsychdoc]

My time is roughly no less than $200 an hour, so, if I am doing something for someone, I am keeping that in mind. If I am losing out on that $200....someone better be dying or paying for a free trip to Europe for me.

 

[Fan_of_Meehl]

I think that psych testing is really misunderstood in the VA. People think it will solve everything, lol.

Realistically, I have seen it being a convenient way for the referring provider to skirt responsibility for doing a thorough differential diagnostic assessment and case formulation for themselves.

 

[texanpsychdoc]

Realistically, I have seen it being a convenient way for the referring provider to skirt responsibility for doing a thorough differential diagnostic assessment and case formulation for themselves.

Indeed - a someone who specializes in testing, I am very astute to the premise behind it and what I use it for - to clarify, and/or to differentiate in an effort to inform and guide treatment planning. With my knowledge in testing/assessment, I apply this in any basic initial evaluation I do for therapy. I will typically recommend or engage in testing when I firmly believe I am not able to take care of it myself in the beginning as a diagnostician. I am pretty conservative when it comes to engaging in testing as I tend to rank order that as being more "invasive" when it may not be necessary to do. I received a lot of referrals at the VA from people who basically didn't even bother to do some rudimentary differential diagnoses to solidify or at least come to a provisional diagnosis....so instead, they toss in a consult and waste my time. In my private practice, I am actually pretty hesitant to engage in testing when I don't think it will add much value to their existing treatment approach or plan.

 

[Fan_of_Meehl]

Indeed - a someone who specializes in testing, I am very astute to the premise behind it and what I use it for - to clarify, and/or to differentiate in an effort to inform and guide treatment planning. With my knowledge in testing/assessment, I apply this in any basic initial evaluation I do for therapy. I will typically recommend or engage in testing when I firmly believe I am not able to take care of it myself in the beginning as a diagnostician. I am pretty conservative when it comes to engaging in testing as I tend to rank order that as being more "invasive" when it may not be necessary to do. I received a lot of referrals at the VA from people who basically didn't even bother to do some rudimentary differential diagnoses to solidify or at least come to a provisional diagnosis....so instead, they toss in a consult and waste my time. In my private practice, I am actually pretty hesitant to engage in testing when I don't think it will add much value to their existing treatment approach or plan.

Yup. Call me old-fashioned but I think that the rank-and-file generalist clinician (hell...even the prescribers (who supposedly base their choice of med regimens on diagnoses)) has the responsibility to at least see the person 2 or 3 times and sink at least 30-60 mins (total) into interviewing and case-formulating the patient as a decent 'first pass' attempt prior to 'ordering' diagnostic 'testing' procedures.

I once did a chart review on a VA patient who had seen multiple providers and even did a friggin THREE MONTH stint in residential where every single clinician 'passed the buck' by retaining a 'R/O bipolar disorder' entry on the guy's chart. So no MH clinician could take the time during a THREE MONTH residential stay? Really?

NOT ONE CLINICIAN spent 15-20 minutes interviewing the individual around pathognomonic symptoms of mania/hypomania (like...has he ever had a distinct change from baseline lasting (continuously) for days-to-weeks representing a change in mood/functioning characterized by things like increased goal-driven dysfunctional behavior (sex, drugs, rocknroll), decreased actual NEED for sleep, etc., etc.

I ruled out history of mania/hypomania in like 20 mins just asking carefully about history of DSM-5 defined criteria for a hypomanic/manic/mixed episode.

He'd had a total of at least 30+ clinical encounters during the time he still had a 'R/O bipolar disorder' entry on his chart.

Ridiculous.