"Procedures" Psychologists Can Do?

[positivepsych]

---

Members don't see this ad.

As far as I've learned, psychotherapy is a poor full-time practice option for new clinical psychologists. From examining job ads and talking to those in practice, this is what I see:

1) Employers now generally hire MSW/MFTs to do it for cheaper, quality be damned.
2) In private practice, insurance panels are already full in populous areas (or require 5+ years licensed), or will reimburse you poorly/improperly.
3) Full-time cash private practices are hard to build, and can only be done by a few savvy psychologists, the rest struggle to fill their practices.
4) You're limited to one location, and have to start over if you move.
5) It's difficult to convince the general public to pay $100+/week, and come back week-after-week. Those who can afford it generally work full-time, and have difficulty skipping work weekly, except on evenings and weekends.

Speaking with my physician colleagues, it seems that the specialties that have the best finances/freedom are ones that do the most "procedures." The more procedures one can do in a given time, or if it requires complexity/ specialization, the better the pay. Psychiatrists are paid by medicare around $60 for a 90862 15-min med check. Unfortunately, the new health & behavior CPT codes for psychologists reimburse $5-25 for 15-minute assessment/interventions. Perhaps they can be used creatively in some way?

I was wondering if there are any procedures we can do as psychologists that address the problems above? I imagine some potential for clinical health psychologists going forward. Let's throw out some CPT codes that are reimbursed well? What about non-psychology CPT codes that we can bill for in unique settings, that don't require us to go outside our scope of practice? Biofeedback? Pre-Surgical Evaluations? Pain Management? Any creative possibilities for new procedures?

 

[erg923]

Biofeedback?

Seriously?....

 

[positivepsych]

Are you implying biofeedback is ineffective?

I believe reviews/meta-analyses have showed that its effective for certain issues:
pain management,
migraine headaches,
epileptic seizures,
stress reduction,
specific psychosomatic issues like IBD.

The ADHD research is controversial, but is potentially promising.

 

[Therapist4Chnge]

I've seen some pretty decent research supporting biofeedback for pain management, though I'm less familiar with the other areas.

 

[Rick55]

We ain't got no stinking procedures. Psychiatry also struggles in this area (with the exception of ECT, but most psychiatrists don't do ECT). There's nothing special about pre-surgical evals. I did them for years and then stopped because the report writing was killing me. You get paid the standard 90801 fee plus any additional psych testing. <br>

Are things really that bad in practice right now? A friend of mine started a new practice a couple of years ago in Portland (Oregon, not Maine) with one other psychologist. He relocated from NYC. He tells me he is doing well, but we don't talk about actual numbers. I know he got on a bunch of insurance panels when he moved out there. I also know he bought a house a year ago, so he had enough money for that. I also know two others that started a practice about three years ago in my area. They didn't mention anything about having problems getting on panels. I don't know anyone practicing in a major city though. Are you in a saturated market?

 

[Rick55]

Someone in my office is a health psychologist and has a biofeedback lab for both research and clinical work. I do not believe that is a cash cow because she still spends most of her time doing therapy (with only a few biofeedback cases here and there). I'm sure if it paid much better than therapy, she would be doing a lot more of it. If you are that interested I can ask her how much it pays relative to therapy. I'm not even sure what code she bills.

 

[erg923]

Are you implying biofeedback is ineffective?

I believe reviews/meta-analyses have showed that its effective for certain issues:
pain management,
migraine headaches,
epileptic seizures,
stress reduction,
specific psychosomatic issues like IBD.

The ADHD research is controversial, but is potentially promising.

Well yes, I think its controversial, but my comment was really directed at the billing aspect. Didnt realize a code existed specifically for it, and have never heard of it being a a lucrative procedure by any means.

 

[Rick55]

Well yes, I think its controversial, but my comment was really directed at the billing aspect. Didnt realize a code existed specifically for it, and have never heard of it being a a lucrative procedure by any means.

erg923 - my guess is that it's self pay. I have never heard of a code for it either.

PP - Have you thought about forensic psych? At least you can get paid what you bill.

 

[positivepsych]

Yes, there are CPT codes for biofeedback. Even the VA system recognizes them. It's just that most places don't even offer it anymore: http://www.futurehealth.org/populum/pagesimple.php?f=Biofeedback-Cpt-Billing-Codes-For-Biofee-75

In the cities around me, the market is rather saturated, and most people can't get on panels, or there is a 2-5 year post-license wait. I love how after 4 years of undergrad and 6 years of grad school/internship/post-doc, insurance companies still think I will be incompetent.

Maybe Portland is different. But even a new psychologist in Georgia reported that BCBS & Aetna wouldn't let him get on a panel for two years: http://forums.studentdoctor.net/showthread.php?p=6698542

I was curious about forensics, but the contract job ads I used to see have disappeared, and are now replaced by ones looking for LCSWs (paying 37.5% of what they were offering us).

I think several people have made an important point about how diversifying a practice is key...

 

[edieb]

somone on here suggested to get on insurance panels quicker, move to an area of the usa with a shortage of mental health providers. apply for panels, keep the rural office open and then move to a better paying area. does anybody remember this advice??

 

[positivepsych]

That's a pretty clever idea. However, it would be very time-consuming and expensive to move and keep an extra office open. It's also ethically questionable. But considering that insurance companies have horrible ethics, I would probably feel more amused irony than injustice if someone pulled it off.

 

[Rick55]

How about taking a job at a hospital or VAMC with the goal of transitioning to a practice after a few years? BTW, my friend in Portland has been out about 5 years, so if that's the issue, it wouldn't have applied in his case.
Forensics - I meant eventually setting up a forensic practice (it would take some time though). I work with someone who transitioned into this area when he was 50 (he's 60 now). He was tired of managed care. He does child custody evals, he evaluates sex offenders, testifies in court a bit--those sorts of things. He's getting about $300 per hour for that work and unlike dealing with insurance, he actually gets paid $300 per hour. When I was in grad school, my advisor always used to say, "All of the money in psychology is in forensics."

 

[Therapist4Chnge]

How about taking a job at a hospital or VAMC with the goal of transitioning to a practice after a few years? BTW, my friend in Portland has been out about 5 years, so if that's the issue, it wouldn't have applied in his case.
Forensics - I meant eventually setting up a forensic practice (it would take some time though). I work with someone who transitioned into this area when he was 50 (he's 60 now). He was tired of managed care. He does child custody evals, he evaluates sex offenders, testifies in court a bit--those sorts of things. He's getting about $300 per hour for that work and unlike dealing with insurance, he actually gets paid $300 per hour. When I was in grad school, my advisor always used to say, "All of the money in psychology is in forensics."

I know a few (senior level) psychologists that make similiar money in assessment (mostly forensic assessment/expert witness work).

 

[HenryHall]

... Pre-Surgical Evaluations? Pain Management? Any creative possibilities for new procedures?

The good thing about pre-surgical evaluations is that the less time you spend on it the more value it has to the client. And the surgeons really only want boilerplate evaluations for CYA purposes with the malpractice insurers.

For example, "Benjamin letters" require a minimum of two sessions of psychotherapy that must be separated by a period at least three months as justification for writing a pre-surgical report. There is no required minimum duration for each session, just a few minutes should be sufficient to a skilled practitioner, longer for a novice. USD2000 is about the going rate, unless more sessions or more elapsed time were involved when it would typically have to be a lower total amount.

 

[Rick55]

The good thing about pre-surgical evaluations is that the less time you spend on it the more value it has to the client. And the surgeons really only want boilerplate evaluations for CYA purposes with the malpractice insurers.

For example, "Benjamin letters" require a minimum of two sessions of psychotherapy that must be separated by a period at least three months as justification for writing a pre-surgical report. There is no required minimum duration for each session, just a few minutes should be sufficient to a skilled practitioner, longer for a novice. USD2000 is about the going rate, unless more sessions or more elapsed time were involved when it would typically have to be a lower total amount.

Aren't those types of evals fairly rare though? I was doing bariatric evals, covered by insurance, so I'd get your typical 90801 money. It's the same situation with organ transplant evals.

 

[PrisonPsych]

The good thing about pre-surgical evaluations is that the less time you spend on it the more value it has to the client. And the surgeons really only want boilerplate evaluations for CYA purposes with the malpractice insurers.

For example, "Benjamin letters" require a minimum of two sessions of psychotherapy that must be separated by a period at least three months as justification for writing a pre-surgical report. There is no required minimum duration for each session, just a few minutes should be sufficient to a skilled practitioner, longer for a novice. USD2000 is about the going rate, unless more sessions or more elapsed time were involved when it would typically have to be a lower total amount.

Can I show my ignorance and ask what a Benjamin letter is?

 

[HenryHall]

Can I show my ignorance and ask what a Benjamin letter is?

First I need to declare that I have no professional interest in all this, my involvement is strictly political/financial/charitable (mostly financial), so take what you like and leave the rest, I don't claim to be an expert, more someone involved day to day as a matter of politics and law.

Benjamin letters is a colloquialism for letters required by malpractice insurers pursuant to pre-surgical evaluations based on a presence, rather than an absence, of psychopathology. It is a consensus view that such diagnosis leans to utility rather than validity, which is why it has a high dollar value (to both malpractice insurer and to self-pay patient) unless too much time is consumed in lengthy evaluations (no-one wants that and it is punished financially).

For a learned discussion of validity versus utility in psychiatric diagnoses see:
http://ajp.psychiatryonline.org/cgi/reprint/160/1/4

For an example of a surgeon who requires such letters and is fairly open about why see
http://www.marcibowers.com/grs/surgery.html

For whatever reason (as a lay person I'm astounded) the empirical observation is that psychologists actively seek out the low paying end of the spectrum of the work they find themselves in. If anyone is short of a research project you might try to dig out the reasons as to why so!

 

[PsyDr]

"There is no required minimum duration for each session, just a few minutes should be sufficient to a skilled practitioner, longer for a novice. USD2000 is about the going rate, unless more sessions or more elapsed time were involved when it would typically have to be a lower total amount."


Henry HAll,

You fail to see the difference between psychologists and psychiatrists.

many states' law dictates that psychologists base their opinions on scientific research with objective measures. you know, like the measures the american academy of bariatric medicine and the VA have suggested psychologists perform. that's right, there are specific STANDARDS psycholoigists are expected to perform, including specific objective measures. under no circumstances does research indicate that "just a few minutes" has ANY correlation with surgical outcome. and no professional organization in psychology advocates such unethical behavior.

i was also under the impression that the shortest session duration you can bill insurance for is 20 minutes (CPT 90804). oh wait, it is.

 

[HenryHall]

...

You fail to see the difference between psychologists and psychiatrists.

Well, you may be partially right that I see insufficient difference, I have the layman's view (PhD versus MD training being the dispositive difference), but ...

... there are specific STANDARDS psycholoigists are expected to perform, including specific objective measures. under no circumstances does research indicate that "just a few minutes" has ANY correlation with surgical outcome.

That is a straw man argument, correlation is entirely your introduction. I see no correlation to outcome either way, nor ever suggested one. I do see that time is money.

. and no professional organization in psychology advocates such unethical behavior.

Another straw man argument, unethical is entirely your introduction. I see no ethics, nor ever suggested any.

i was also under the impression that the shortest session duration you can bill insurance for is 20 minutes (CPT 90804). oh wait, it is.

Yet another straw man argument, insurance is entirely your introduction. I never mentioned insurance. Though I did refer to self-pay. Self-pay is in some senses the opposite of insurance.

Really, you may have a valid case, but putting up straw man arguments only detracts from it.

Straw man argument: A straw man is a fallacy in which an irrelevant topic is presented in order to divert attention from the original issue. The basic idea is to "win" an argument by leading attention away from the argument and to another topic.

 

[psychmama]

Henry Hall - forgive me, but I don't understand. If you're a "lay person" as you suggest, why do you come onto this forum and post as if you are a credible source of information about topics related to psychology? When challenged, it seems to me that you retreat and state you don't have a personal stake in the argument. So why are you posting here? It would help if you'd clarify that (assuming you're willing to do that, of course).

 

[Ollie123]

I understand the utility/validity distinction, but I'm very confused about how length of evaluation is being factored in here. Specifically, it sounds like you are implying that the longer the evaluation the less utility it has. From a purely financial perspective it makes perfect sense - diminishing returns and all. However, even in the article you cite, utility is about much more than that. Specifically, it distinguishes between the value of a diagnostic label and information on etiology, prognosis, potential to inform treatment, etc. This is actually a good bit more complicated and elaborate than a pure diagnostic model (assuming it is done well). I think I must be misunderstanding your point, because I cannot fathom any possible situation when a legitimate practitioner can obtain that information in a few minutes.

 

[PsyDr]

HH,

i disagree. it is somewhat difficult to argue with you, as you lack the knowledge base for why some of my points are relevant. you then cite my points as irrelevant. i can understand this. it would be difficult for me to argue law. but then again, i don't stalk law student forums and tell the students what to do or express special knowledge of things.

You claim that one can perform bariatric surgery evals for $2000USD and need only see the patient for a few minutes.

this is simply not possible in psychology for the following reasons:

-it is unethical. unethical behavior has legal ramifications in psychology, much like law (which you claim to practice). Your suggestion that someone perform a bariatric surg eval "in a few minutes" and charging two grand is like saying that you can make a lot of money helping an accounting dept disguise a failure to report up the ladder. sure, you CAN make money doing this kinda crap, but it is unethical. and depending on the state, unethical behavior has legal consequences.

-deviation from standard of care. opens you up to lawsuits. hence, using measures that are found to be correlated and predictive of successful surgical outcome.

-billing: record keeping laws largely dictate that a psychologist keep accurate records of their professional activities. this includes CPT codes, which only allow 20+ min of time spent with the patient.


then again, i have only done about 122 bariatric surg evals to date. so tell me more about my profession.

ps. adding you to my list of people who i think are not who they purport to be on this message board.

 

[psychmama]

HH,

i disagree. it is somewhat difficult to argue with you, as you lack the knowledge base for why some of my points are relevant. you then cite my points as irrelevant. i can understand this. it would be difficult for me to argue law. but then again, i don't stalk law student forums and tell the students what to do or express special knowledge of things.

You claim that one can perform bariatric surgery evals for $2000USD and need only see the patient for a few minutes.

this is simply not possible in psychology for the following reasons:

-it is unethical. unethical behavior has legal ramifications in psychology, much like law (which you claim to practice). Your suggestion that someone perform a bariatric surg eval "in a few minutes" and charging two grand is like saying that you can make a lot of money helping an accounting dept disguise a failure to report up the ladder. sure, you CAN make money doing this kinda crap, but it is unethical. and depending on the state, unethical behavior has legal consequences.

-deviation from standard of care. opens you up to lawsuits. hence, using measures that are found to be correlated and predictive of successful surgical outcome.

-billing: record keeping laws largely dictate that a psychologist keep accurate records of their professional activities. this includes CPT codes, which only allow 20+ min of time spent with the patient.


then again, i have only done about 122 bariatric surg evals to date. so tell me more about my profession.

ps. adding you to my list of people who i think are not who they purport to be on this message board.

hmmm...

 

[Therapist4Chnge]

then again, i have only done about 122 bariatric surg evals to date. so tell me more about my profession.

How have you found the reimbursements for the evals? I've been told that depending on the CPT code and clinican, that it is often not financially viable to do them. Ive seen some pretty spartan work-ups, but the proper ones seem to require much more than can be billed.

 

[PsyDGrrrl]

Forensics - I meant eventually setting up a forensic practice (it would take some time though). I work with someone who transitioned into this area when he was 50 (he's 60 now). He was tired of managed care. He does child custody evals, he evaluates sex offenders, testifies in court a bit--those sorts of things. He's getting about $300 per hour for that work and unlike dealing with insurance, he actually gets paid $300 per hour. When I was in grad school, my advisor always used to say, "All of the money in psychology is in forensics."

Just to be clear, forensic work is something you don't just do on a whim. It takes a lot of training to become a proficient and respectable forensic psychologist, which is why setting up a practice would take a good deal of time if this is a new area of practice for you.

 

[BohuMSW]

1) Employers now generally hire MSW/MFTs to do it for cheaper, quality be damned.

lololololololololololol sorry about that one bro. hope you find some good "procedures" so you can make physician money like your "colleagues."

 

[Therapist4Chnge]

Just to be clear, forensic work is something you don't just do on a whim. It takes a lot of training to become a proficient and respectable forensic psychologist, which is why setting up a practice would take a good deal of time if this is a new area of practice for you.

It can be great pay, BUT you have to be very careful because of the liability issues, higher likelihood of getting sued, etc.

 

[PsyDGrrrl]

It can be great pay, BUT you have to be very careful because of the liability issues, higher likelihood of getting sued, etc.

Also depends on what area of forensic practice you do. You're more likely to get sued for civil cases (especially child custody) than criminal.

 

[Annakei]

Just wanted to point out that just because someone is hired as a masters level clinician, it doesnt mean that their work is any less than that of a doctoral level clinician. There are both good and bad clinicians on both the doctoral and masters level.

I often wonder about the real world experience level of those who make such comments, when you've worked on an interdisciplinary team, you realize that people are judged based on their individual strengths and not the letters behind their name. Don't be so quick to paint MSWs/MFTs with such a broad brush.

Carry on...

As far as I've learned, psychotherapy is a poor full-time practice option for new clinical psychologists. From examining job ads and talking to those in practice, this is what I see:

1) Employers now generally hire MSW/MFTs to do it for cheaper, quality be damned.
2) In private practice, insurance panels are already full in populous areas (or require 5+ years licensed), or will reimburse you poorly/improperly.
3) Full-time cash private practices are hard to build, and can only be done by a few savvy psychologists, the rest struggle to fill their practices.
4) You're limited to one location, and have to start over if you move.
5) It's difficult to convince the general public to pay $100+/week, and come back week-after-week. Those who can afford it generally work full-time, and have difficulty skipping work weekly, except on evenings and weekends.

Speaking with my physician colleagues, it seems that the specialties that have the best finances/freedom are ones that do the most "procedures." The more procedures one can do in a given time, or if it requires complexity/ specialization, the better the pay. Psychiatrists are paid by medicare around $60 for a 90862 15-min med check. Unfortunately, the new health & behavior CPT codes for psychologists reimburse $5-25 for 15-minute assessment/interventions. Perhaps they can be used creatively in some way?

I was wondering if there are any procedures we can do as psychologists that address the problems above? I imagine some potential for clinical health psychologists going forward. Let's throw out some CPT codes that are reimbursed well? What about non-psychology CPT codes that we can bill for in unique settings, that don't require us to go outside our scope of practice? Biofeedback? Pre-Surgical Evaluations? Pain Management? Any creative possibilities for new procedures?

 

[psychmama]

Just wanted to point out that just because someone is hired as a masters level clinician, it doesnt mean that their work is any less than that of a doctoral level clinician. There are both good and bad clinicians on both the doctoral and masters level.

I often wonder about the real world experience level of those who make such comments, when you've worked on an interdisciplinary team, you realize that people are judged based on their individual strengths and not the letters behind their name. Don't be so quick to paint MSWs/MFTs with such a broad brush.

Carry on...

Annakei,

I couldn't agree more with you. There are good and not so good clinicians across all disciplines and experience levels. However, the fact remains that it can be disconcerting to see others with a master's degree doing the same work as those with a doctorate. After all -- why get the doctorate if there's no difference in career possibilities? What I'm trying to say is that there are some legitimate reasons to care about scope creep other than just snobbery.

 

[Therapist4Chnge]

Annakei,

I couldn't agree more with you. There are good and not so good clinicians across all disciplines and experience levels. However, the fact remains that it can be disconcerting to see others with a master's degree doing the same work as those with a doctorate. After all -- why get the doctorate if there's no difference in career possibilities? What I'm trying to say is that there are some legitimate reasons to care about scope creep other than just snobbery.

One of the biggest areas of concern I see with scope creep is in the area of assessment.

 

[PsyDr]

annakei,

you bring up intergroup variability, which is incredibly different than intergroup variability.

if group A has 3-7 years more education than group B then there is a difference in knowledge base in those . EPPP studies demonstrates this. the law recognizes this difference in many states' licensing laws.

there is also a difference in the entrance criteria for most doctoral programs. look at the GRE scores of applicants accepted to MA vs. PhD or PsyD. there is a significant difference.

the fact that you are upset does nothing to counter the tenet of the OP which seems to be that those groups with more education have a better chance at performing better quality of work. this is even recognized in the training model wherein state laws generally require substanitally more suprevision after graduation for MAs.

is your work "less" than mine? yup.

 

[Therapist4Chnge]

It is important to acknowledge that people are judged by the letters after their name in a multi-disciplinary team. The lens in which they view the case must be taken into account, as it informs their judgment, therefore the letters after their name at least have to be considered.

I had a case awhile ago where a pt. was skipping some of his appointments, and when confronted he got agitated, defensive, and said he was never told he had the appointments. The confronting staff person swore that she told him during morning meds, just like she did the day before, and that he just didn't want to miss out on XYZ. A second staff person shared that his behavior was suprising because he had always been nice to her and made her scheduled appointments. A third staff person spoke to the pt. and wrote a consult for a neuro eval. Why?

The third person reviewed the chart and saw some assessment data that suggested some cognitive impairment, and based on the previous events decided to make a consult for a neuro evaluation, because there was most likely some short-term memories issues at play. I did the neuro eval and confirmed her suspicion.

 

[Annakei]

Let's be clear. I am not upset. Hardly. 🙂

Your "knowledge" is just a piece of paper until you put it to work. As I've said before, I know many doctoral and masters level clinicians on both sides of the spectrum. In fact, I know quite a few MSWs that are better clinicians than some of the PhDs/PyDs and vice versa. At the end of the day this is just a pi$$ing contest for the different disciplines which I have no interest in pursuing. Psychiatrists are mad about some psychologists wanting Rx rights and psychologists are worried about masters level clinicians getting testing and assessment rights. Just worry about doing your job well, there's plenty of work out there for every one if they want it. I've worked long enough in the field to know this for myself.

I dont believe that it simply comes down to your years of education but the quality of that education. There are some diploma mills out there giving degrees to anyone who will pay. The PhD from Walden that isn't accredited and some of whom I personally know are poorly lacking in clinical skills are somehow better than the MSW coming from a program that is accredited and known for pumping out solid clinicians? Why? Just because they have 3-7 more years? Ha! 👎

So, is your "knowledge" better than theirs? Nope. It comes down to solid skills which aren't automatically conferred just because you pulled more years in grad school. Some come out after 7 years and still struggle with conceptualizing a simple case.

This isn't a jab at anyone either, I dont need to "go there", but what I am saying is just because you are a doctoral level clinician, this does not automatically make you better than the masters level clinician next to you.

annakei,

you bring up intergroup variability, which is incredibly different than intergroup variability.

if group A has 3-7 years more education than group B then there is a difference in knowledge base in those . EPPP studies demonstrates this. the law recognizes this difference in many states' licensing laws.

there is also a difference in the entrance criteria for most doctoral programs. look at the GRE scores of applicants accepted to MA vs. PhD or PsyD. there is a significant difference.

the fact that you are upset does nothing to counter the tenet of the OP which seems to be that those groups with more education have a better chance at performing better quality of work. this is even recognized in the training model wherein state laws generally require substanitally more suprevision after graduation for MAs.

is your work "less" than mine? yup.

 

[Annakei]

lololololololololololol sorry about that one bro. hope you find some good "procedures" so you can make physician money like your "colleagues."

LMAO! Yes, I just keep thinking the OP is in the wrong field

 

[Annakei]

Annakei,

I couldn't agree more with you. There are good and not so good clinicians across all disciplines and experience levels. However, the fact remains that it can be disconcerting to see others with a master's degree doing the same work as those with a doctorate. After all -- why get the doctorate if there's no difference in career possibilities? What I'm trying to say is that there are some legitimate reasons to care about scope creep other than just snobbery.

I agree with you re: scope creep. However, one thing I am confident in is my work, so are the psychologists that I work with and the last thing on their minds is the battle going on in my region for testing/assessment rights. They are concerned with doing good work and as such they see the fruits of their labor through increased referrals.

So while I understand the concern, I think it has more to do with realizing that a Masters level clinician can do the work of a doctoral level clinician. And they do it well. It happens every day where I work and the doctoral level psychologist is pretty happy with the outcome 🙂

Furthermore, the only place I hear of this pi$$ing contest is the psych boards. This is never entertained in or around my workplace because we all have great admiration and respect for what we bring to the table. Ive been a member here on SDN for some time and I've brought this issue up as a Bachelor's level student, grad student and now masters level licensed clinician. My former clinical director only warned about going to a diploma mill and understanding the reputation of the school you choose. Professors from my grad program are the same way and they have very successful private practices ranging from testing/assessment, therapy to forensic work. The PhDs are hardly worried about the PsyDs, psychiatrists not at all about the psychologists wanting Rx rights and especially the prominent PhD psychologist in our area who hired our firm to perform great forensic work for his practice. Even bringing up this issue with him in training, this wasn't an issue at all. *shrug* I think the people who are concerned are the folks mostly relying on the letters behind their name to bring them business. Focus on quality and the rest will fall into place. I'm very happy with the way that things have worked out in my world 🙂

And again, this isnt a digg at any of the doc level folks, all I am saying is that in *my* world, this "issue" is a nonissue for my colleagues who run the gamut as far as a multidisciplinary team goes...

 

[edieb]

No, quality does not always take care of itself. That is so naive. Managed care is not concerned about quality of work. If it were, it would demand the most highly trained person to perform services. However, if it can get away with it, it will hire a PA rather than an MD/DO or a LCSW rather than a PhD/PsyD. THis is because managed care is concerned about keeping costs low, quality be damned. Hence, scope creep by master's level practitioners.

I don't believe someone with a 2 year degree that does not contain any assessment courses can do as good of a job as a PhD with 7 years of school + 1-2 years of post-doc. Not only do master's programs lack the quantity of programs in regards to assessment; the courses are much more cursory in nature. In addition, PhD/PsyD students learn on-the-job with closely supervised practica, internships and post-docs. Assessment isn't about cutting and pasting the computer generated score report.

RxP is a completely different story because:
1 - Master's level practitioners want to do PhD work without any extra education/training.
2 - Psychologists want to prescribe with an extra master's degree.

If you want to do assessment, get a second master's degree. Otherwise, don't touch it

I agree with you re: scope creep. However, one thing I am confident in is my work, so are the psychologists that I work with and the last thing on their minds is the battle going on in my region for testing/assessment rights. They are concerned with doing good work and as such they see the fruits of their labor through increased referrals.

So while I understand the concern, I think it has more to do with realizing that a Masters level clinician can do the work of a doctoral level clinician. And they do it well. It happens every day where I work and the doctoral level psychologist is pretty happy with the outcome 🙂

Furthermore, the only place I hear of this pi$$ing contest is the psych boards. This is never entertained in or around my workplace because we all have great admiration and respect for what we bring to the table. Ive been a member here on SDN for some time and I've brought this issue up as a Bachelor's level student, grad student and now masters level licensed clinician. My former clinical director only warned about going to a diploma mill and understanding the reputation of the school you choose. Professors from my grad program are the same way and they have very successful private practices ranging from testing/assessment, therapy to forensic work. The PhDs are hardly worried about the PsyDs, psychiatrists not at all about the psychologists wanting Rx rights and especially the prominent PhD psychologist in our area who hired our firm to perform great forensic work for his practice. Even bringing up this issue with him in training, this wasn't an issue at all. *shrug* I think the people who are concerned are the folks mostly relying on the letters behind their name to bring them business. Focus on quality and the rest will fall into place. I'm very happy with the way that things have worked out in my world 🙂

And again, this isnt a digg at any of the doc level folks, all I am saying is that in *my* world, this "issue" is a nonissue for my colleagues who run the gamut as far as a multidisciplinary team goes...

 

[deleted176373]

As far as I've learned, psychotherapy is a poor full-time practice option for new clinical psychologists. From examining job ads and talking to those in practice, this is what I see:

1) Employers now generally hire MSW/MFTs to do it for cheaper, quality be damned.
2) In private practice, insurance panels are already full in populous areas (or require 5+ years licensed), or will reimburse you poorly/improperly.
3) Full-time cash private practices are hard to build, and can only be done by a few savvy psychologists, the rest struggle to fill their practices.
4) You're limited to one location, and have to start over if you move.
5) It's difficult to convince the general public to pay $100+/week, and come back week-after-week. Those who can afford it generally work full-time, and have difficulty skipping work weekly, except on evenings and weekends.

Speaking with my physician colleagues, it seems that the specialties that have the best finances/freedom are ones that do the most "procedures." The more procedures one can do in a given time, or if it requires complexity/ specialization, the better the pay. Psychiatrists are paid by medicare around $60 for a 90862 15-min med check. Unfortunately, the new health & behavior CPT codes for psychologists reimburse $5-25 for 15-minute assessment/interventions. Perhaps they can be used creatively in some way?

I was wondering if there are any procedures we can do as psychologists that address the problems above? I imagine some potential for clinical health psychologists going forward. Let's throw out some CPT codes that are reimbursed well? What about non-psychology CPT codes that we can bill for in unique settings, that don't require us to go outside our scope of practice? Biofeedback? Pre-Surgical Evaluations? Pain Management? Any creative possibilities for new procedures?

90807 will get you $10/appt more money than 90806. 90807 is appropriate if you are reconciling the medications your patient is one, at least that is what my practicum clinic site seems to think. $99.90 is what medicare allows vs the $89.08 for the appointment without the medication reconciliation.

Mark

 

[deleted176373]

So while I understand the concern, I think it has more to do with realizing that a Masters level clinician can do the work of a doctoral level clinician. And they do it well. It happens every day where I work and the doctoral level psychologist is pretty happy with the outcome 🙂

And again, this isnt a digg at any of the doc level folks, all I am saying is that in *my* world, this "issue" is a nonissue for my colleagues who run the gamut as far as a multidisciplinary team goes...

So if that's the case, why bother with Doctoral level psychologists at all? Obviously they aren't bringing additional values if the Masters level clinician can do all the work of a doctoral level psychologist.

Mark

 

[psychmama]

I agree with you re: scope creep. However, one thing I am confident in is my work, so are the psychologists that I work with and the last thing on their minds is the battle going on in my region for testing/assessment rights. They are concerned with doing good work and as such they see the fruits of their labor through increased referrals.

And again, this isnt a digg at any of the doc level folks, all I am saying is that in *my* world, this "issue" is a nonissue for my colleagues who run the gamut as far as a multidisciplinary team goes...

Listen -- you sound happy and clear about your role in the system. Great, but that doesn't prove there are no problems. I work on an interdisciplinary team as well, and we generally show respect and professionalism with one another. That doesn't mean there are no tensions between us -- it means we try to rise above it and treat each other as we'd want to be treated. I'm a gal who tends to get along with most of my coworkers. I still notice the diffferences between the disciplines and the competition that's out there in the marketplace. I think it's a real concern for many (certainly not all) psychologists.

 

[PsyDr]

annakei,

a couple of things:

1) there is a difference between "skills" and "knowledge". to which are you referring ?

2) If a degree is "just a piece of paper"?, then what do you think is a suitable demonstration of knowledge? EPPP scores? cause doctoral level providers score higher on that too. please account for the intergroup differences using non-education based explanations, since you deride education as meaningless.

3) please cite non anecdotal evidence that high level MA programs score comparably to the low ranked PhD/PsyD programs.

4) please explain why doctoral level RVUs are higher than MA level. again, non-anecdotal evidence please.

5) if intragroup differences are so high as to exceed intergroup differences, then please explain why joe GED should not practice psychotherapy without any formal psychology/counseling education.

6) if you are referring to skill, please cite outcome evidence that MAs perform better than BA level clinicians.

 

[AryaStark]

Also,
Note that when making points, he/she references the schools that are "diploma mills." The majority of people do not get their doctorates from these programs. If you have to measure your best programs to our "worst" programs, that seems a little fishy. Additionally, the majority of us go to APA acc. schools where we receive extensive training with HOURS AND HOURS AND HOURS of supervision.

If we are going to go off of anecdotal evidence, my best friend is getting her MSW at a highly respected program. However, her MSW program allowed their students to be put into a placement as a "therapist" BEFORE their first day of classes. At most PhD programs, we need to get a sound background through class work before we are anywhere near the clients. I know for a fact that the majority of her classes focus on policy rather than the empirical results of psychotherapy studies. Also, I have to take two assessment classes, ethics class, a psychopathology class, supervision class, and a specialized population class before I am even allowed to THINK about seeing clients. How can you give adequate support to somebody before you even have the proper background? At most, they got a quick run through of ethics before seeing their first clients? Is this appropriate?!?

In addition, how can you equate 3 years of part time therapy needed for an MSW to the (at some programs even longer) 4 years part time plus 1 year full time internship plus 1-2 years full time post doc of a PhD/PsyD?

Just because you can read a manual doesn't mean that you have had the adequate amount of time necessary to be competent nor does it mean that you have the understanding of WHY it works and how to best implement this.