Ethics of this 1099 contract clinical psychologist job

[deleted595120]

Hi there,
I applied to this job (link below) out of curiosity and a New Year's resolution to make some extra money to save up for a house one day.

https://www.glassdoor.com/job-listing/contract-licensed-psychologist-aba-centers-of-america-JV_IC1154535_KO0,30_KE31,53.htm?jl=1009528345863

They are essentially wanting a psychologist to oversee their psychometrists and sign off on assessment reports. It's a remote position and they video record all their testing (ados etc) and provide all the protocols then I provide feedback and check testing and review the report. While it seems like a great side gig (you make your own hours) I wanted to check in about any ethical hang ups. Maybe because it's remote it's feeling odd?

I am considering consulting with apa ethics which I hear is free. I am all for not gate keeping an autism dignosis and early access to intervention but I want to be mindful and be ethical! Any thoughts? Any psychologists doing similar jobs? Thanks!

---

Members don't see this ad.

 

[PsyDr]

If you sign something, you own the liability for it.

 

[psych.meout]

Ethics aside, I'd be concerned that it's worth your while and that they don't have unreasonable expectations.

They're offering $150/hour for chart review, the evals, report writing, written and/or oral feedback, etc., which seems pretty low to me, especially since this is a 1099 position (and I wonder if it even meets the criteria for independent contracting, but that's a different story). I'd be curious how much payors are giving them for each eval and what proportion of that you'd typically be getting. It doesn't say what their expectations are in terms of how many evals you need to complete per week or how many hours you're allowed to bill for each eval, though I'd suspect that the latter is pretty low like many other assessment situations, like C&P and other disability evals typically are. I.e., they wouldn't let you bill the full amount of time it would you to do a good job with every aspect of these evals, but would expect them to be done in significantly less time, which means less pay for you and more stress and pressure.

They require you to "comply with ABA Center’s of America KPIs of chart review and signature. KPI states up to eighty chart signatures and review per week is the expectations," but I don't know what constitutes a chart "signature." "Up to" also doesn't tell us how many is typical or how many full evals they expect per week.

One interesting part is that they require you to "maintain all active licenses and apply for new state licenses upon request." I wonder if you'd be able to get that hours rate for all the leg work you have to do to get licensed in a new state if they tell you to do so.

 

[deleted595120]

If you sign something, you own the liability for it.

I realize that?

 

[Freud’sMommy]

Aside from the poor pay, there are several other issues. For starters, the workload is off the charts—you’re expected to sign off on up to 80 charts a week, with evaluations due in just 7 to 14 days. Sure, because quality clearly takes a backseat when you can crank out reports like assembly-line widgets, right? That kind of pressure makes it nearly impossible to uphold the thoroughness and ethical standards our profession actually demands.

Then there’s the whole supervision angle. You’d be overseeing psychometrists who administer tests, yet most of that supervision appears to be done remotely. In practical terms, you might end up merely “rubber-stamping” reports rather than actively ensuring that every testing condition meets best practices. So, you really have to ask yourself: are you truly in a position to verify that these folks are competent, or are you just hoping for the best while your name gets attached to their work?

And let’s not overlook the dazzling $5,000 bonus for referring BCBAs. It might sound enticing until you realize it could create conflicts of interest or even be construed as fee-splitting—concepts our ethical guidelines would lovingly roll their eyes at. While extra cash is always appealing, it’s a slippery slope when financial incentives start nudging your clinical judgment.

Then there’s the matter of the clinical work itself. The job expects you to perform pediatric neuropsychological assessments using tools like the ADOS-2. If your expertise isn’t squarely in pediatric or autism spectrum assessments, you’re essentially being asked to step into a minefield, risking practicing beyond your competence—a clear ethical red flag.

And, oh joy, the telehealth and multi-state practice issue. The listing hints that you might need to obtain additional state licenses on the fly, because who doesn’t love a good legal maze? As a 1099 contractor, you’d also be under relentless pressure to meet strict KPIs, which could push you to choose speed over quality—adding yet another layer of ethical risk to an already precarious situation.

If you’re seriously considering this role, your best move is to ask plenty of questions before signing on. Clarify exactly how many psychometrists you’ll be supervising, get a real picture of the workload, and understand exactly how that referral bonus works. Make sure you’re covered with the proper licensure for all the states you might have to work in and that you have the support you need to document and manage everything properly. Reducing waitlists for autism diagnoses is a noble mission, but not at the expense of your clinical integrity—or your peace of mind. Not to mention this patient population (especially in Braintree, MA) is relative quick to pull the trigger on filing board complaints.

 

[ClinicalABA]

Interesting. There is definitely a need for quality ASD diagnosticians in Massachusetts. I'd be curious as to whether or not this would be purely for existing ABA clients and, if not, are you expected to only refer to ABA Centers of America for treatment. In Mass, a child under three can receive ABA services with a diagnostic "letter" from a physician (and, soon, a nurse practitioner). Once they turn 3, services switch over from the Early Intervention system to purely insurance, and insurances usually require a more in-depth testing and report. Some agencies need the soon-to-be three kids to get that diagnosis so they can continue to get services. If that Is even small part of what this job is about, be wary- there's a lot at stake for these children, and you not giving a diagnosis will result in that child losing MANY hours per week of services (10-30+), which will result in employees of ABA Centers of America losing their positions and the company not getting paid. That can piss off a lot of people. You'll probably find that for most kids it won't be an issue as the diagnosis is valid, but it shouldn't be a surprise that a non-zero number of kids who were given a diagnosis after a 20 minute office visit just because they didn't make eye contact got incorrectly diagnosed. It's not a lot of kids, but it's definitely some.

While some here have commented on the $150 per hour being low, it is WAY more than Mass medicaid rates for any of the services you will likely bill. Remember the population you'd be dealing with. Young kids have young parents, and young parents tend not to have a lot of money and are more likely to have public insurance. With this job you're either dealing with more well-to-do families that can afford to fight you if you mess up, or ABA Centers of America is having you operate at a loss in order to help these families continue services (my vote is on the latter- people with money and resources get their kids in for assessments somewhere else).

As @PsyDr points out- you own these cases. If something goes wrong, they will come after you. ABA Centers of America not only won't help you out, their Attorneys will probably point the finger of blame in you direction. Do you have personal malpractice insurance? How are you protecting your personal assets against any work related "challenges" against you (i.e., are you set up as an LLC with appropriate filings with the state department of revenue)? I think you'll find that pretty much everyone on this forum who does private practice or consulting is set up as an LLC or other business type that separates their business and personal assets.

IANAL, but employee referral bonuses are very common in this field and I know of no cases where it has been an issue. BCBAs are hard to find and are key to the business model. That said, you technically would not be an employee of this agency (see below about that), so I wonder if/how you'd be eligible for such a referral bonus. We have these at my agency, but not even all our employees are eligible to receive them (I am in my position, and I have received one).

I think there are bigger issues about how you'd be classified as an independent contractor. See below for regs and guidelines for employee classification in Massachusetts:

https://www.mass.gov/info-details/independent-contractors-0

There seems like a lot of company rules/requirements that you'd have to follow, so I'm not sure how it meet the first standard for being an independent contractor:

From Mass General Laws: "(1) the individual is free from control and direction in connection with the performance of the service, both under his contract for the performance of service and in fact;"

On a more personal level, I could not imagine doing this type of work. It takes out all of the fun stuff (actually being on the floor in the room with the child and their family), and leaves just less fun (to me anyways) stuff, like writing reports.

It really sucks that families can't access good diagnostic services, and thus can't access appropriate therapy services. This position probably is just an attempt to make it easier for families. Company founder had child with ASD. Though it seems like a very big company with a national footprint, doesn't seem like they've gotten into bed with private equity yet, which- IMHO- is a good thing. It just seems like a position that is not well thought out (or relies on the "independent contractor" doing the hard work and taking the risks). Be wary of this one.

 

[PsyDr]

I realize that?

I don't think you understand your potential liability thoroughly.

1) Malpractice liability: "Dr., did you EVER personally examine the patient? Your job duties are to perform neuropsychological evaluations. This patient has atypical Wilson's disease, and you NEVER looked at their eyes. Is that standard of care for neuropsychological evaluations? So your deviation from standards led to life long neurological damages." Boom. You're in trouble. For the 15 years plus whatever record keeping time period.

2) Is there any way for you to know that the noncustodial parent has agreed to treatment? Your job description says you are supposed to do the normal standard of care. If there is a problem, and they screw up, it is on you. They can say, "Well your job description says you are supposed to do the standard of care, and that didn't happen, so you were not operating as our employee when that happened, so you are personally liable".

3) Criminal liability: Are you ABSOLUTELY sure that your NPI isn't being used to bill for the psychometricians for patients you never see? I'm pretty sure that insurance laws say you have to see a patient, in order to bill for psychometrician time. If they bill under your name, for someone you never see, and you sign it, there is an argument that you are committing insurance fraud. That's makes this a criminal issue. It's not "paying a fine", it's "going to prison". And yes, that actually happens.

To me, this job sounds like Barney Stinson's job.

It sounds good, but your timeline that will basically be, “Your normal contracted 8 hr work day is Monday, and we filled that up with clinical work, but your contract also says that you have to write 10 reports, and sign 70 things, at some point in between your face to face work.” That's not going to happen during your actual work day. Write out your name 80 times. It's more time than you think. You’re being robbed.

 

[ClinicalABA]

I don't think you understand your potential liability thoroughly.

1) Malpractice liability: "Dr., did you EVER personally examine the patient? Your job duties are to perform neuropsychological evaluations. This patient has atypical Wilson's disease, and you NEVER looked at their eyes. Is that standard of care for neuropsychological evaluations? So your deviation from standards led to life long neurological damages." Boom. You're in trouble. For the 15 years plus whatever record keeping time period.

2) Is there any way for you to know that the noncustodial parent has agreed to treatment? Your job description says you are supposed to do the normal standard of care. If there is a problem, and they screw up, it is on you. They can say, "Well your job description says you are supposed to do the standard of care, and that didn't happen, so you were not operating as our employee when that happened, so you are personally liable".

3) Criminal liability: Are you ABSOLUTELY sure that your NPI isn't being used to bill for the psychometricians for patients you never see? I'm pretty sure that insurance laws say you have to see a patient, in order to bill for psychometrician time. If they bill under your name, for someone you never see, and you sign it, there is an argument that you are committing insurance fraud. That's makes this a criminal issue. It's not "paying a fine", it's "going to prison". And yes, that actually happens.

To me, this job sounds like Barney Stinson's job.

It sounds good, but your timeline that will basically be, “Your normal contracted 8 hr work day is Monday, and we filled that up with clinical work, but your contract also says that you have to write 10 reports, and sign 70 things, at some point in between your face to face work.” That's not going to happen during your actual work day. Write out your name 80 times. It's more time than you think. You’re being robbed.

This. The job probably was not set up to take advantage of anybody. They probably really have a need for kids to get diagnosed, and figured- in the same way many other ABA companies (including the one I work for) have- we can do the diagnosis part ourselves! From what I can tell, the company does not provided any other psychological services, and there aren't any psychologists in licensed positions. If they tried to hire one as an employee, they probably had difficulties finding one or figuring out how to do that, and arrived at the "1099 Psychologist" option (though likely it doesn't meet criteria for an independent contractor, and it's weird that that's what they call the position). That's the best case scenario- a poorly thought out move that is actually in line with their mission of doing what it takes to provided maximum services to their clients. On the other hand, it could actually be a money grab whereby people in a dark board room decided to pass all the risk onto some sucker psychologist who will just rubber stamp things. Thing is, it really doesn't matter what the intent is- all the risk is still on you. It's in the job description that you'd be responsible for "conducting supervision and training of all Psychometrists in the region/state"- putting more risk on you (and how will you train them and how will they pay you to train them?).