I really think your missing the point here. The problems neuropsych is facing, (and im talking clinical practice issues here, those working within NIH dont have to worry about keeping a referal base and the economic realities of PP settings and hospital billing) have little to do with the current recession. Its a problem of reibursement cuts, (which alll insurance providers will quickly follow suite, since they see medicare as setting the bar) and a professional division that prevents us from moving forward at an acceptable pace. If you dont see this, then you are either in an insulated position (ie., NIH) that has little in common with the practice settings most npsych work in, or you're just not paying attention.
Im not sure what world you're in, but npsych within a non-academic medical center setting (the vast majority of hospitals) is a financial drain on the hospital. You might be turning some profit for them, but its not much. Therefore, its an expendable specialty in most hospitals and clinics. Trust me, i have heard this from way more than one than hospital adminstrator. Job security doent mean alot when you cant find one to begin with.
Lastly, we have done a poor job at marketing ourselves and our services, both to the public and to our referal sources. "Weekend warriors" pull down our reps whuch makes PP neurologists less likley to refer. However, where we have been the worst as a profession is actually demostrating that what we do is cost efficient for anyone involved! Across all aspects of health care (of which our little neighborhood is a teensy-weensy part), payors are asking for outcomes data (e.g., cost savings, differences in clinical outcome) with increasing frequency. This is true whether you are discussing surgical procedures, medical procedures, or which medications they will include on their formularies (or the extent to which these medications will be covered for given therapeutic conditions).
Note that "outcomes data" is a completely different animal from "how well does this procedure clarify the diagnosis?" An expensive procedure may well help clarify a muddy diagnostic picture but have minimal impact on either the patient's clinical outcome or the cost of managing the patient. In my experience, if you can demonstrate a very compelling difference in clinical outcome as a result of a procedure, the managed care company will be hard pressed not to cover it unless the cost is just nightmarishly insane (unless you are in Europe, in which case the cost has only to be a little wacky to get denied).
Simply put, we don't have these data. We have data that we can clarify diagnostic thinking, we have position statements from medical societies agreeing with this, and we even have some data that our results can predict some clinically important phenomena (e.g., disruptive behavior on nursing home units, legal competencies). But these are not outcomes data. In the very near future, we are going to need data that demonstrates that patients end up in nursing homes later, live longer, require less in the way of other treatment modalities, etc., if we are going to continue to be paid.
If I am the insurer, I'll be asking questions like "OK, given that most patients diagnosed with dementia never see a neuropsychologist, can you demonstrate the quantifiable clinical or cost benefits of having seen one?" Payment for our services will slowly continue to get uglier until we can answer this question affirmatively.