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EPPP Step 2: $$$

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by G Costanza, Jan 6, 2018.

  1. G Costanza

    G Costanza Psychologist - Private Practice

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    Here’s an interesting read about the company that is the driving force behind an EPPP Step 2.

    Spoiler: They suck.

    The American Psychologist Licensure 'Crisis' Explained - Modern Psychologist

    Allowing a company to double its influence as our field’s gatekeeper after already showing it cannot even create a test without spelling errors should be concerning. I feel terrible for those who will have to shell out another $600 just to jump through another arbitrary hoop.
     
    #1 G Costanza, Jan 6, 2018
    Last edited: Jan 6, 2018
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  3. psych.meout

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    I would link to the original post instead of using that particular site. It's author was formerly a regular here and I think he was eventually banned. He was combative to say the least and perpetuated some weird ideas and arguments. It looks like he gave his website quite the facelift.
     
  4. G Costanza

    G Costanza Psychologist - Private Practice

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    Is that right? I’ve been around this site for some time but usually avoid the drama.
     
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  5. foreverbull

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    The article's concerns are valid. There's no need for a second test, plain and simple. As the article mentions, disciplinary rates for psychologists are low. There are a few bad apples in every field who do slip through, but some folks will always slip through because they know the rules inside and out, but choose not to follow them. We can't predict that via tests outside of assessing knowledge unless we also administer personality tests!

    No one in the field wants to talk about what a cash cow these tests are for the ASPPB.

    I don't mind the idea of testing skill/practice competence, but context is everything with practice, so multiple choice may not capture any meaningful information about level of practice from a brief vignette. That's why we have 3-5 years of practicum, 1 year of internship, and 1-2 years of postdoc in which we are supervised closely! Supervisors and our graduate programs should be the gatekeepers prior to licensing.

    My thinking is that if a practice-related portion is added, halve the EPPP 1 questions and add 125 practice-related questions so that there is no additional test expense to graduate students. Stop forcing grad students to bear higher and higher costs for licensing tests!
     
  6. G Costanza

    G Costanza Psychologist - Private Practice

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    Exactly. On the surface, it appears to be a business monopoly that is free to raise prices for a consumer with almost no power. At the risk of being extreme, it has a flavor of extortion.
     
  7. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    You won't find much empathy from other disciplines on the cost issue. Our costs to licensure and boarding pale in comparison to many med specialties, even when you take into account differences in salary. As for testing itself, while I would be fine with another organization or the ASPBB to clean up its act somewhat, I actually believe in more rigorous testing procedures, in some form. Far too many incompetent providers out there are diploma mills flooding the markets with sub-par practitioners. Programs and supervisors should be the gatekeepers of the profession, but when you have incompetent/unscrupulous supervisors and or programs already, you just perpetuate the cycle of ****ty people getting into the field. I'm all for a better system, but I've never seen anyone propose anything new that actually speaks to tightening the competency restrictions. Most people just want to complain about cost and difficulty without much substance.
     
  8. MamaPhD

    MamaPhD Psychologist, Academic Medical Center
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    Competency-based evaluation is here to stay. That said, there are several back-end quality control mechanisms that could be streamlined or eliminated if the profession got serious about quality control in doctoral training, committed to a national standard for licensure, and embraced board certification (ie, ABPP) more widely. Personally, I'd like to see the National Register become obsolete.

    And yes, Modern Psychologist appears to be run by a person(s) who have a special axe to grind when it comes to ASPPB. I don't think any organization is above scrutiny, but I'm not sympathetic to the idea that barriers to entry in the profession are too high, and that's what a lot of their crowing seems to boil down to.
     
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  9. foreverbull

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    Program oversight is what I believe needs to change, not testing at the very end after folks who shouldn't be practicing are pushed through. I believe APA should be at the helm of ensuring (tighter) competence, not ASPPB.

    I think part of the issue is we may have some programs in fear of retaliation from students (via suing, etc.) and loss of income to programs when you kick students out (at the masters level, I saw a student fail both practicum and multicultural issues and yet was allowed to repeat them both and graduate, which terrified me to think about this person out in the field), as well as supervisors fearing that students with poor practica performance will reflect negatively on them as professionals. Ultimately these and other factors need to be addressed by programs to ensure the highest standards of training in addition to more scrupulous oversight by APA, which would eliminate the need for changes in testing.

    Just because other fields also pay high licensing exam fees doesn't make it right, is my response. Across the board students are getting gouged when it comes to licensing exams. A portion of the fees are justified for operating costs/test development, but not all of it. Where are those leftover dollars going every year in a nonprofit?
     
    #8 foreverbull, Jan 7, 2018
    Last edited: Jan 7, 2018
  10. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    APA should be, yes. But, they've made it clear by loosening standards and allowing the proliferation of diploma mills for years now, that they are not interested in ensuring competence in the field. So, it comes down to licensing bodies. Some one needs to do it. As for the testing fees. Logistically, they are pretty low. I don't really buy the gouging argument when you look at the costs of organization, refinement, and implementation.
     
  11. Harry3990

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  12. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    Let's be clear. This is a somewhat poorly written opinion piece, with not much substance. Some interesting ideas, maybe, but it'd be a huge stretch to call this thing an article.
     
  13. foreverbull

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    I think information provided about a nonprofit that keeps its meetings closed and private (when deciding licensure level competence for an entire nation's psychologists to protect the public) and makes certain expenses vague, has a history of increasing exam prices, and doesn't provide any empirical support (just hearsay) for a new licensing test that they plan to push states to use is substantive, regardless of how it was written.

    If you look at ASPPB's own website and FAQs about the Step 2 exam, they don't offer any evidence that the test is needed; they simply discuss differences in training models, supervisor pressure to pass students (with no citation given), and a range of Eppp pass rates by program as suggesting need to create a second test (huh?). There's also no evidence that the new test will predict better outcomes than the current test.

    That in and of itself should be a huge red flag to all psychologists.
     
    #12 foreverbull, Jan 8, 2018
    Last edited: Jan 8, 2018
  14. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    As I said, interesting ideas, but lacking on any sort of intelligent follow through or commentary. Most organizations, state licensing bodies included, hold portions of meetings in private. It's not uncommon at all. Just how exactly do they keep expenses vague? I would like to see some actual justification for that.

    As for the need, it's a consensus issue here and going along with the rest of the medical field that some competence testing happen that focuses on identified areas of clinical competence. Of course, we could just eliminate the test entirely and let anyone who wants to practice. I have yet to hear any sort of coherent action plan besides foundationless griping. If people want to actually do something about it, maybe they should intelligently discuss an alternative instead of bitching about what is a pretty low cost and an easy test which offers little to no real barrier of entry into the field.
     
  15. boomshakalaka

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    The current bar for entry into the profession is ridiculously low. Why do we need a step-2? Because of this drivel at the end of the page:

    "We thank all of you psychologists coming forward lately with these abuses and fighting against these cowards, And we encourage You to continue sending us Your stories and leaks. You can do so completely anonymously by sending your documents via www.sendspace.com, directly to our e-mail at [email protected], or any other PGP encrypted messaging that you may use. Together we will continue dismantling these cartel schemes, which are essentially harming the public.

    #TheNewAPA #APA2018"

    Everyone beware of the psychology illuminati.
     
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  17. foreverbull

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    Sometimes articles are written to draw attention to issues so that readers can discuss the concerns and come up with solutions. But that takes work from us readers. The subtext of the article is that there's no incompetence crisis going on in our field, so why fix what isn't broken?

    We already take comps, which IS competence testing. If it isn't mandatory, then programs and/or APA can make it so. As I said before, APA should step up here to take the lead on competence at the program/training level, and if they don't, then perhaps some folks in here who feel strongly about competence should work their way into evaluating training programs via APA and setting a higher baseline of competence rather than "griping" about diploma mills and the bar being set too low.
     
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  18. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    I can't think of a single colleague who is doing clinical work who would agree with that.
     
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  19. foreverbull

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    Hence the second part of my response for folks who want stricter standards.
     
  20. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    Already answered that one in response earlier. The APA has already decided it won't be that entity. I'm fine with ASPPB being a dedicated gatekeeper. I'm fine with that bar being higher.
     
  21. G Costanza

    G Costanza Psychologist - Private Practice

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    Has anyone ever seen a study showing the EPPP has any predictive validity? I’d appreciate a link or cite.
     
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  22. psych.meout

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    Aren't you one of the people on this forum who is always defending the people who went to unfunded programs?

    See, this is a valid question about the issue. Complaining about conspiracies, cartels, etc. isn't really a coherent argument.
     
  23. foreverbull

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    Not sure how this relates to the topic at hand....would you like to clarify why you are asking?

    Not sure whom you're referring to here. I never asserted a conspiracy, and note that the original article was not from Modern Psychologist. The original article was from: http://thepsychologytimes.com/psyc-times-pdfs/The-Psychology-Times-Vol-8-No-12.pdf. I have no affiliation with folks on the Modern Psychology site.

    Any organization that introduces an entirely new (additional) test for licensing in our field should stand up to a little further scrutiny and provide a solid basis for the need for the additional test. Note that ASPPB didn't even use citations in their own argument for why the EPPP Step 2 is needed on their website/FAQs. I'd like to see some research support; that is a completely reasonable request from an organization that is setting some of the requirements for licensure.
     
  24. PBCocce

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    EPPP "step 1" was already ridiculous enough.
     
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  25. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    I agree, no reason for the bar to be so low.
     
  26. Icculus8

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    So I saw that the Step-2 is planned to roll out in January 2020, and the description sounds like it will still be a series of multiple choice, computer-scored assessments of skills. It is hard to imagine how effective clinical skills will be assessed via computer based assessment, although I've not taken the original EPPP so this might at least be a step in the right direction.

    EPPP Step 2 FAQs - The Association of State and Provincial Psychology Boards
     
  27. BuckeyeLove

    BuckeyeLove Forensic Psychologist
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    that dude....modern psychologist........dude was a bit off
     
  28. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    Maybe he's just trying to pad his resume for a job with Alex Jones.
     
  29. foreverbull

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    As I've mentioned before, if adding clinical questions and truly ensuring that it isn't about money, they should halve the EPPP1 and insert 125 clinical questions so there's no additional financial burden.
     
  30. WisNeuro

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    I imagine they still want to assess both domains to a certain extent. And, relatively speaking, our licensure exam is cheap and much faster than some areas in healthcare. Still seems like a reasonable, and probably still too low, bar to clear.
     
  31. Justanothergrad

    Justanothergrad Counseling Psychologist
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    I talked with them about it at APA last year and their explanations weren't any more convincing either.

    I mean, it should be cheaper. We make less comparatively. It's a low bar to clear - the question is if it is a meaningful bar.
     
  32. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    I'm all for research into it's predictive validity. But, I fail to see how we are disproportionately affected by the cost, so that argument is bunk to me.
     
  33. Justanothergrad

    Justanothergrad Counseling Psychologist
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    If we are going to compare exam fees by profession as ASPPB does to make present the argument that the costs are not irregular then earnings should also play a role in that discussion it seems to me. This gives the best context for cost comparison. We have lower starting salaries and lower upper ends than any of the fields they list in their offered up webinar comparisons. Regardless of if I don't think it's entirely out of sync/disproportionally impactful, it should be lower than other medical professions given the nature of the comparison/argument they are making with respect to costs.

    Part of the ASPBB purpose for this is, after all, to compare those with post-docs and those without as an effort to discuss needs to lengthen our required training length/format ("Results will inform the discussion for the need of post-doc as a requirement for licensure"). Again, this could impacts earnings and seems a relevant point of discussion. I don't suspect they'll revisit the costs later to adjust it if this is something they use to justify that in the future.
    http://c.ymcdn.com/sites/www.asppb.net/resource/resmgr/eppp_2/EPPP2_Webinar_Presentation.pdf
     
  34. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    It looks wholly proportional to say, physicians. to me. Actually, proportionally, we're getting a much better deal than say family medicine, pediatrics, neurology, and psychiatry if we want to look at ranges of salary.
     
  35. ClinicalABA

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    Do you know if physicians have better between-state licensure reciprocity than we do?
     
  36. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    I imagine it depends quite a bit. I have pretty broad reciprocity at this point. My wife had to go through a few hoops in our last move, took a while.
     
  37. cara susanna

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    I am completely opposed to EPPP step 2. Yes, I am familiar with modern psychologist and agree that this individual has an axe to grind. But even a broken clock is right twice a day. If you are making psychology trainees pay more to take an exam, the burden of proof should be on you to demonstrate that it's needed. And, even if it is, that adding this second step would fix the problem.

    I am aware that other professions have more expensive licensure processes than we do. But they also tend to pay more.
     
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  38. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    It's pretty proportional when you look at median incomes.
     
  39. Justanothergrad

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    1. I agree that the cost burden is similar to the median incomes of some other health professions if you look at BLS statistics. That said, our ranges of income aren't as good as many of the professions being compared and if you broke down distributions of salary into quartiles or spend any time with it. We just don't earn the same as many other medical fields. Heck, lets just compare the VA, the largest employer of psychologists. Say you are a stepped out GS13 psychologist. You don't earn what a physician earns, much less a specialist. MDs start around 95k and have a cap around 210k as I recall. That is not true of psychologists. In general- it's cheaper by a dollar amount, but it should be.

    2. Presenting information comparing costs is completely irrelevant to if the EPPP2 is useful/needed/incremental/valid at all for what it is intended.
     
  40. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    I agree, but it seems to also be the main anti argument in this issue. Which, by looking at the numbers, doesn't really hold a lot of water.
     
  41. Justanothergrad

    Justanothergrad Counseling Psychologist
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    Eh, It is probably more complicated than just comparing mean incomes as exemplified by the VA income data. That side, the bigger criticism I have always raised with it is a question of incremental validity or validity at all. Since we know so little about the operational definitions that may be problematic determined... Which is a problem of itself
     
  42. WisNeuro

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    Of course, but we at least do have several figures to draw from if people want to try and argue the money angle. And, with what we do have, the argument falls flat most ways you look at it.

    As for the question of any meaningful substance, the incremental validity. I totally agree. My guess is that the initial push is to align our licensing procedures along with most of healthcare in testing both knowledge and clinical skills that are felt to be necessary to competently work in the field being tested. Something, I very much agree with. It's a first step, though I suspect it will do little to keep the chaff out of the field as is currently happening anyway. As to the data that people want, I think it will be a long time coming, if at all. The resources necessary to meaningfully follow people long-term and adequately test outcomes would be extremely costly. So, the argument would pertain to any and all licensing bodies in healthcare. They do not have the data either, they have individuals in the field who have agreed that a certain bar should be necessary for entry into the field. So, we either pony up a few tens of millions of dollars to do some research, or we conclude that there should be zero barriers into the practice of healthcare, no matter the level of care someone is providing.
     
  43. ExecutiveDysfunction

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    Is there any evidence there’s a quality control problem in psychology? I mean I’m assuming these concerns are based off of data other than the EPPP and not just anecdotal, correct? Genuinely curious for sources.
     
  44. Justanothergrad

    Justanothergrad Counseling Psychologist
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    Well, there is argosy
     
  45. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    And Fielding, Alliant, Albizu, etc. Also, just work in the clinical realm for a few years and you'll see that there is indeed a quality control problem. But, as stated before, this move is likely to bring psychology into alignment with how many other advanced practice disciplines set their licensing process up. Long overdue, IMO.
     
  46. ExecutiveDysfunction

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    I’ve definitely seen it already and I’m just nearing the end of internship myself. I would like to be optimistic and hope it’s not rampant and it’s just a few bad apples, but definitely want to be cautious about basing a big change on anecdotal data.
     
  47. WisNeuro

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    Meh, it's a pretty small change, really. This will likely be easier than the EPPP for most.
     
  48. smalltownpsych

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    When this was being discussed prior with the infamous ModernPsychologist, one point was that we should have some of these tests earlier in the process and that would be more consistent with medicine who take their tests during med school. I would be more on board with that, I think, than just adding one more test at the end of postdoc. I also don’t see how this would help stem the tide of Argosy, Alliant, and Albizu so is it really worth it to add one more hurdle to the long process we have to go through before we can actually make money?
     
  49. ExecutiveDysfunction

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    I agree. All schools (at least ones I’m aware of) have competency exams. Why not make that our standardized “Step 1” with the EPPP?
     
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  50. WisNeuro

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    Well, first you'd have to get schools to agree to a standardized competency exam process. There is a huge variation in how schools do this. Also, the diploma mills would fight this tooth and nail considering their students have market difficulty passing the exam even after accruing knowledge through internship and postdoc.
     
  51. cara susanna

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    That's the thing, though. Even if there is a competency crisis, how is this exam going to fix it? I agree with an above post that says clinical decision-making is nuanced and depends a lot on the situation, which cannot be adequately addressed by an exam question.

    I fall more on the side of addressing this at the program-level. The bottleneck should not be internship and I definitely don't think it should be licensure.
     
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  52. WisNeuro

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    I do think a clinical competency exam can help, especially with implementation and fine-tuning, you have to start somewhere. I'd love to see the issue addressed at the program level, but have serious doubts at that happening, ever. As it stands, it is up to the states to decide what they would like to implement as a licensure guideline. And, I fully support their choice in adopting this if they so choose. They can't rely on the quality control on the front end, so they are free to regulate it on the back end as they see fit.
     

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