Justification and value for psychologist on inpatient unit

[erg923]

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Our facility (VAMC) is considering NOT refilling our inpatient psychologist position. Ours recently retired. Not sure he was really "be all you can be" up there (think he was just doing groups more than anything else)...so higher ups are seemingly unconvinced that there really needs to be a psychologist there. Beyond the argument that a psychologist can fill a valuable assessment (MMPIs, diagnostic clarifications, etc) and consolation role, I'm wondering what we could do or say to convince hospital admin that we are of value there over and above LCSW or other masters level providers?

I am imagining the building a true psychology service within inpatient psychiatry that provides diagnostic, C&L, triage/referrals, and brief therapy role. Less focus on doing groups-we have LPC that works there and can do most of those. Other ideas? Its a 18 bed unit (14 psych and 4 detox).

I am sure if I do all this work for my chief, they will probably solicit me for this position. **** it. Ill do it. )Its a shorter commute too. 🙂

 

[singasongofjoy]

Any argument you could make that a good psychologist doing all those things is more likely to get folks better and out of there quicker will probably be a huge sell. Or any way that you could show that you could either 1) save money or 2) bring money in by also providing better/more services than the current guy sounds like he is doing. Numbers talk... I know a VA psychologist who was basically able to keep his job because he ran numbers showing how much money he was actually saving the unit with efficient triage and implementing more follow-up/partial or outpatient services to cut down on return visits, which was obviously also better for the clients (he was saving them more money than his relatively higher salary was costing them). Show them some dollar signs 🙂 Good luck!

 

[Therapist4Chnge]

Looking at re-admissions, length of stay, and any staff injuries due to pt behavior. There is some literature on this, I'm guessing the primary care division for APA would know some references.

 

[PsyDr]

Find malingerers. Nuff said.

 

[WisNeuro]

We don't use the "m" word in the VA, wouldn't want one o them Congressional letters or nothin.

 

[erg923]

Find malingerers. Nuff said.

VA enables this. They would not really view this as selling point.

 

[Rivi]

There was an article about the role of psychologists on inpatient units, but I can't seem to find it.

I think our selling points are: more specialized individual and group therapy options than LPC's, malingering tests, brief suicide prevention interventions, diagnostic assessments, outcome measurements.

 

[Therapist4Chnge]

I'd love a citation if you can find one. I've come across a few related articles over the years, but I never saved any of them.

 

[smalltownpsych]

Psychologists are the best and isn't that what we want for our servicemen? Also, our expertise of legal and ethical issues can give us an edge in any setting where legal and ethical problems could be a concern for administrators. 😉

 

[deleted407083]

I know in child psych, psychologists create and implement behavioral plans. I wonder if this would be applicable. You typically do some brief-focused psychological assessment and create behavior plans, which theoretically should improve length of stay, lower costs, etc.

I would also love any articles on inpatient psychologists and the benefit over master's level clinicians.


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[ClinicalABA]

Psychologists are the best and isn't that what we want for our servicemen?

Yeah, but this- and much of the other points mentioned above- were actually disproved by the actions (as reported by erg923) of the ACTUAL PSYCHOLOGIST who was in the position. The bird may have flown on this one- your're left with a psychologist saying that psychologists are valuable as a counterpoin to a psychologist whose behavior was not valuable (relative to his pay above an LICSW rate). Seems to me that any good argument must be prefaced by clearly establishing that what the last guy did was not actually psychologist level work requiring psychologist level pay.

There are just to many of us who want to be paid more, respected more, etc. (and trained less, but that's a different post), than MA level clinicians who do the same thing. This hurts the field.

 

[Therapist4Chnge]

Someone in that position would need to identify things that can't be done by mid-levels and/or are a much better fit for psychologists.

1. Capacity Evals
2. Beh. plans (should be experts in)
3. Outcome research
4. In-service staff trainings (e.g. Beh management)

Etc.

 

[ClinicalABA]

Someone in that position would need to identify things that can't be done by mid-levels and/or are a much better fit for psychologists.

1. Capacity Evals
2. Beh. plans (should be experts in)
3. Outcome research
4. In-service staff trainings (e.g. Beh management)

Etc.

#s 2 and 4 can be and often are done better and cheaper by certain "mid-levels," and are in no way the domains of psychologists any more.

 

[Therapist4Chnge]

I highly doubt a capacity eval can be done better by a mid-level, particularly in regard to medical decision making. The psychologist should be using assessments and not just doing a clinical interview and record review.

 

[bcliff]

I highly doubt a capacity eval can be done better by a mid-level, particularly in regard to medical decision making. The psychologist should be using assessments and not just doing a clinical interview and record review.

Capacity/neuro eval/rule-out, C&L, outcomes research/tracking, bx medicine/brief interventions all come to mind -- is this for an integrated pc type position or for a standalone psychologist?


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[erg923]

Thanks everyone.

I have do have some background in designing positive behavioral support plans. However, it's an acute psych unit. Average length of stay is 5 days.

 

[ClinicalABA]

I highly doubt a capacity eval can be done better by a mid-level, particularly in regard to medical decision making. The psychologist should be using assessments and not just doing a clinical interview and record review.

Oops- edited to say "#2 and #4"

 

[smalltownpsych]

Yeah, but this- and much of the other points mentioned above- were actually disproved by the actions (as reported by erg923) of the ACTUAL PSYCHOLOGIST who was in the position. The bird may have flown on this one- your're left with a psychologist saying that psychologists are valuable as a counterpoin to a psychologist whose behavior was not valuable (relative to his pay above an LICSW rate). Seems to me that any good argument must be prefaced by clearly establishing that what the last guy did was not actually psychologist level work requiring psychologist level pay.

There are just to many of us who want to be paid more, respected more, etc. (and trained less, but that's a different post), than MA level clinicians who do the same thing. This hurts the field.

Agreed. You might need to throw that guy under the bus if they were indeed dissatisfied with his performance. I say if because we are often harder on each other than anyone else is. We have to be careful about this.

Also, erg, keep in mind that it will likely be an emotional decision more than a rational one. It's political and you have to sell them. We don't have to have the level of evidence to demonstrate improved efficacy that we think we need to make our case. I think that is a mistake that we often make. In other words, I believe that having a psychologist on the unit makes the most sense, but that is difficult to prove. That doesn't matter if I can sell it to the decision makers. The opppsite is also true, even if I have solid evidence on my side, if I can't sell it then it won't happen.

 

[smalltownpsych]

Further along the lines of what I was saying above, who the decision makers are and what their perceived needs and fears are is what we need to know to sell the idea to them.

 

[PsyDr]

Since revenue generation, differential diagnosis, and detection of malingering are out; I'd point out that jcaho and most states require a psychologist on staff for psych hospitals. Something something mirroring civilian standards.

 

[Therapist4Chnge]

Being able to get physician support from the unit can really help; your presence can make their job easier. On the civilian side I've seen this also being framed as a way to increase physician billing because the physician can bill more out-pt because they aren't getting stuck on the in-pt unit (which is typically a loss-leader for a hospital). I guess in VA terms it would be, "being able to provider greater access to more Veterans"…something like that. You could also appeal to the optics, as the VA (depending on the VA hospital) continues to struggle with timely psychiatric service, and this would be a way to increase access.

 

[EmotRegulation]

Why is a psychologist important? I recall an internship supervisor who used to talk about one of the things psychologists have over other mental health providers is a good knowledge base about human behavior. We're required to take developmental, cognitive, social psychology courses for "breadth" ideally so we can understand more about what makes people tick--not just what makes people go wrong. I'm aware this isn't an argument for a Chief or medical board, but it is a recognition of the different training given to psychiatrists, psychologists, social workers and LPCs. I'm also well aware this is my value system talking as someone who studies clinical psychology through a social psychology lens.

I guess my point is not just that psychologists are capable of DOING stuff other providers aren't capable of doing, or aren't capable of doing as well. It's a different depth of training about human behavior, and particularly when talking about people in acute crisis (which means not only managing the people but also thinking about intergroup relations among staff, the milieu of the unit, etc.) psychologists can provide an important perspective.

 

[erg923]

Why is a psychologist important? I recall an internship supervisor who used to talk about one of the things psychologists have over other mental health providers is a good knowledge base about human behavior. We're required to take developmental, cognitive, social psychology courses for "breadth" ideally so we can understand more about what makes people tick--not just what makes people go wrong. I'm aware this isn't an argument for a Chief or medical board, but it is a recognition of the different training given to psychiatrists, psychologists, social workers and LPCs. I'm also well aware this is my value system talking as someone who studies clinical psychology through a social psychology lens.

I guess my point is not just that psychologists are capable of DOING stuff other providers aren't capable of doing, or aren't capable of doing as well. It's a different depth of training about human behavior, and particularly when talking about people in acute crisis (which means not only managing the people but also thinking about intergroup relations among staff, the milieu of the unit, etc.) psychologists can provide an important perspective.

Well, in this case it is about "doing." And about RVUs. Outside academia, this is what sells.

Looks like the position will probably come through based on standards of care and revamping of the previously established job duties/responsibilities. I give it 70/30 (for) based our current fiscal and the political climate here.

I continue to have some personal investment and interest here, as my grad school research (not so much clinical training) focused on SMI evaluation. I am the assistant TD here, and it would be nice to be better positioned/located in the main medical center as opposed to the suburban CBOC I'm currently working in order to build our training programs and infrastructure. I have other interests too, but this seems the most appealing way to build on my current influence within this facility. That said, my skill set and career is definitely more aligned with outpatient health and primary care psych. I will keep everyone updated!

This is situation is what happens when psychologists get lazy and fall into the role of "therapist" only.

 

[PsyDr]

Plus we're better looking.

 

[StellaB]

Currently in an inpatient hospital with psychiatrists and LCSWs. In addition to what others have said already, psychologists at my hospital do risk assessments (suicide, violence). Not sure if that's relevant for a VA inpatient, but thought I'd throw it out there since it didn't look like anyone else did. Good luck!

 

[CheetahGirl]

Currently in an inpatient hospital with psychiatrists and LCSWs. In addition to what others have said already, psychologists at my hospital do risk assessments (suicide, violence). Not sure if that's relevant for a VA inpatient, but thought I'd throw it out there since it didn't look like anyone else did. Good luck!

Totally relevant at VAMCs, especially the Suicide Risk Assessment.

@erg923 - Do you have a Suicide Prevention Coordinator at your VA, especially one who frequents the inpatient psych unit? There is a VA mandate now for suicide safety planning (per Clay Hunt SAV Act, www.congress.gov/bill/114th-congress/house-bill/203), which, of course, can be done by any MH professional and prior to discharge from an inpatient unit. For your unit, who follows those with high-risk suicidality after discharge? Most Suicide Prevention Coordinators are licensed psychologists, with SW or MHC as assistants

 

[PsychPhDone]

Plus we're better looking.

I mentioned this thread to my non-psychologist husband and this was also his reply. N of 2.🙄

 

[LM02]

Obviously this is irrelevant to the specifics of a VA setting, but one of the challenges in employing psychologists in an inpatient setting more broadly is that their work cannot be easily billed, as everything that we might do "on the surface" is incorporated into other billing codes. I am credentialed at 3 different hospitals, including a free-standing psychiatric hospital, and none of them employ psychologists on the units for this very reason.

 

[LM02]

Totally relevant at VAMCs, especially the Suicide Risk Assessment.

@erg923 - Do you have a Suicide Prevention Coordinator at your VA, especially one who frequents the inpatient psych unit? There is a VA mandate now for suicide safety planning (per Clay Hunt SAV Act, www.congress.gov/bill/114th-congress/house-bill/203), which, of course, can be done by any MH professional and prior to discharge from an inpatient unit. For your unit, who follows those with high-risk suicidality after discharge? Most Suicide Prevention Coordinators are licensed psychologists, with SW or MHC as assistants

Our SPC is a social worker.

 

[CheetahGirl]

Our SPC is a social worker.

LCSW SPCs have to work with someone with admitting privileges, and/or probably takes them straight to the ER when follow-up leads to admission.

For @erg923, this is another place where a full-time psychologist would benefit, for inpatient evals, follow-up, could work w/ cover the SW SPC and partial-coverage for AOD staff (there's always an MD in the ED to admit them).

 

[smalltownpsych]

Obviously this is irrelevant to the specifics of a VA setting, but one of the challenges in employing psychologists in an inpatient setting more broadly is that their work cannot be easily billed, as everything that we might do "on the surface" is incorporated into other billing codes. I am credentialed at 3 different hospitals, including a free-standing psychiatric hospital, and none of them employ psychologists on the units for this very reason.

This points out an important issue and why midlevels are taking over in a lot of settings. Why pay for a doctor when the midlevels can bill the same stuff for half the salary? We (psychologists) are most vulnerable because we are actually stupid enough to tout the data that says that training doesn't predict outcomes as opposed to challenge it.

 

[CheetahGirl]

We (psychologists) are most vulnerable because we are actually stupid enough to tout the data that says that training doesn't predict outcomes as opposed to challenge it.

Not me...not anymore. I've had instances (post-graduate) in grant and contractual preparation where I've had to justify why a clinical psychologist was needed (vs. other types of staff). Kind of neat to see in writing (and have it approved) the benefits that a psychologist has beyond a psychiatrist or social worker/mental health counselor.

However, when it comes time for me to pull for myself (salary compensation), I will be beating down SDN's door, so to speak, and perusing all the old threads to bolster my confidence to ask for what we (I) am worth. Helps that my business-minded husband is always like when he sees my paycheck (knowing all that I do that goes into my work).

 

[deleted407083]

Not me...not anymore. I've had instances (post-graduate) in grant and contractual preparation where I've had to justify why a clinical psychologist was needed (vs. other types of staff). Kind of neat to see in writing (and have it approved) the benefits that a psychologist has beyond a psychiatrist or social worker/mental health counselor.

However, when it comes time for me to pull for myself (salary compensation), I will be beating down SDN's door, so to speak, and perusing all the old threads to bolster my confidence to ask for what we (I) am worth. Helps that my business-minded husband is always like when he sees my paycheck (knowing all that I do that goes into my work).

If anyone has any literature on this, that would be awesome!

Might be a good idea to find (or do) an up-to-date meta-analysis of the literature regarding benefits of psychologists within hospitals to justify higher salaries. Would be useful to bring to employers!!


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