Recent NPsych Listserv Post Annoyed Me

[NewNeuroDemic]

As the title says, a recent post to the NPsych listserv annoyed me. The post is an important and valid one regarding test security in California. Yet one of the author's points that supposedly speaks to the urgency of the matter was annoying. To quote:

"...However, the urgency grows each day. Defense attorneys are desperate to find experts who will agree to the demands and have started reaching out to newly licensed, non-boarded neuropsychologists with no forensic experience."

The explicit suggestion that being newly licensed and non-boarded are some serious concerns is stupid and ignores the clear fact that the poster was themselves once newly licensed and non-boarded. I very much doubt they waited some length of time to start doing forensic work. Then, the poor defense attorneys are forced due to being so desperate to seek out such a person. What horror! I chafe at the notion that we (I) must wait to practice in this area until older practitioners deem me worthy. To me, the poster is conflating being newly licensed and non-boarded with being ill prepared and uneducated because clearly only the newly licensed and non-boarded would acquiesce to inappropriately disseminating test materials and data. Please.

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[futureapppsy2]

I mean, it's more that if someone is unlicensed/unboarded in a field where that's expected, it's going to be extremely easy for opposing council to rip them apart for that on cross-examination for lacking verifiable credentials that align with the suugested expertise.

 

[WisNeuro]

In my experience, the listserv poster's comments are entirely well-founded based on what I actually see happening quite often. Also, nearly everyone I know doing IME/forensic work, did indeed come into that portion of their career after working in other settings from some years. I can only think of 1 or 2 people who started out IME work from the get go, and they are not people I would refer to, for many reasons.

 

[AcronymAllergy]

Just to add, it's also possible the poster was suggesting that someone who is newly-licensed may be more susceptible to being pressured by attorneys to comply with evaluation demands/may have less experience or feel less comfortable with pushing back. And yes, having no forensic experience is a place we all were at one point, but my read, as I mentioned, is that the poster is implying that it's a tactic to essentially try to take advantage of folks with less/no experience who essentially may not know better (i.e., that they don't have to agree to the exam stipulations).

I personally wouldn't have stepped near a medicolegal eval when I was newly-licensed, but that speaks as much to my own risk tolerance as anything else.

 

[MCParent]

Like others I don’t read that as saying new folks are stupid. I think it’s describing new rules that are annoying for whatever reason to people who have done the expert work for years, and now they don’t want to do it as much (I’m guessing for legit reasons). So the attorneys have to get new people who might not be as good at testimony and might not be as good assets to their case for the reasons others mentioned. 🤷‍♂️

 

[WisNeuro]

Like others I don’t read that as saying new folks are stupid. I think it’s describing new rules that are annoying for whatever reason to people who have done the expert work for years, and now they don’t want to do it as much (I’m guessing for legit reasons). So the attorneys have to get new people who might not be as good at testimony and might not be as good assets to their case for the reasons others mentioned. 🤷‍♂️

A little different than that in this case. This specific example has to do with a recent CA case and release of data directly to attorneys. The case is not precedent, but some new providers may misread it as such and acquiesce to demands by attorneys that undermine test security.

 

[Therapist4Chnge]

I personally wouldn't have stepped near a medicolegal eval when I was newly-licensed, but that speaks as much to my own risk tolerance as anything else.

This. I trained under a number of experienced neuropsychologists, and they taught me a lot about navigating diff types of legal work. They also taught me to be risk averse. I was 4+ years into my academic career before I dipped a toe in the water. I slowly built up my experience, but now it is a significant part of my practice (10+ yrs since fellowship). I only work in a couple of niche areas, so I can focus on knowing the research very well. I screen all of my cases and learned not to feel bad rejecting cases that were a poor fit.

 

[PsyDr]

1) The original thread was about a CA case law, which would require psychologists to disclose test materials to attorneys. This would destroy test security. The case law allowed for future revisions, if psychologists rebuffed the idea. ABCN is trying to state that no psychologists would allow disclosure of tests. Such assertions may stop CA from requiring disclosure of test materials.

2) I disagree with OP's take on the email. I think the email meant to convey the idea that ECPs, being less financially and professionally secure, may take CA cases under these circumstances.

3) I think #2 is MUCH more insidious. The idea that financial limitations are inherent to ECPs, is a significant problem. You don't see that in medicine. If those financial limitations are a problem for the field in general, then the field needs to pay people better.

 

[Sanman]

1) The original thread was about a CA case law, which would require psychologists to disclose test materials to attorneys. This would destroy test security. The case law allowed for future revisions, if psychologists rebuffed the idea. ABCN is trying to state that no psychologists would allow disclosure of tests. Such assertions may stop CA from requiring disclosure of test materials.

2) I disagree with OP's take on the email. I think the email meant to convey the idea that ECPs, being less financially and professionally secure, may take CA cases under these circumstances.

3) I think #2 is MUCH more insidious. The idea that financial limitations are inherent to ECPs, is a significant problem. You don't see that in medicine. If those financial limitations are a problem for the field in general, then the field needs to pay people better.

You didn't see that in medicine. In recent years, it is starting to creep in. From Opiod mill pills to botox parties I am seeing more physicians (often younger millennials in primary care specialties) that don't feel the financially secure and are looking to boost their income (often to contend with student loan payments).

It is an even larger problem in our field. We have seen the FSPS programs target forensics and neuropsychology as the moneymakers and try and produce more with the promise of big incomes. As it becomes harder to make good money with bread and butter treatment, I am sure more and more folks will be tempted to breach ethical lines to make a dollar. It happens a lot more in the mid level professions due to numbers, but the state of healthcare in the U.S. compared to things like tech will mean that more people will feel the financial pressure.

 

[Therapist4Chnge]

I have definitely seen early career primary care branch off in Derm-Lite procedure work like botox. Primary Care reimbursements continue to suffer and PCPs (who take commercial insurance and medicare) have to grind through a day to make ends meet. Utilizing midlevels is one way to squeeze a bit more profit out, but that can also lead to predatory setups and/or poor oversight. Most states have independent NP practice, though some require more supervision and oversight; then there are PAs who have to review cases with the MD/DO.

As for programs that push higher salary specialities, they really are a disservice to the students because they are not producing quality providers. Those specialities are competitive for internship and fellowship, and without real experience and mentorship, those students are likely going to slip through the cracks as generalists. Selfishly, I don't care as much because when I come up against them in the forensic world they are easy to shred, but it is bad for our field. Add those students to the "do it on the side" (for extra income) clinicians, and there are a lot of bad "experts" out there.

 

[Therapist4Chnge]

1) The original thread was about a CA case law, which would require psychologists to disclose test materials to attorneys. This would destroy test security. The case law allowed for future revisions, if psychologists rebuffed the idea. ABCN is trying to state that no psychologists would allow disclosure of tests. Such assertions may stop CA from requiring disclosure of test materials.

I know the foibles of the typical state licensing board can make interactions interesting, but to even consider disclosing test materials to attorneys is asinine. Why would *any* psychologist agree to that? Did they not bother to consult the CA Psych Assoc or a few local "experts"?

 

[WisNeuro]

I know the foibles of the typical state licensing board can make interactions interesting, but to even consider disclosing test materials to attorneys is asinine. Why would *any* psychologist agree to that? Did they not bother to consult the CA Psych Assoc or a few local "experts"?

The cesspool that is practice in CA on the legal side has failed in protecting test security for some time now. It was already the easiest state to compel recording/TPO in. This was just the logical next step in CA.

 

[boomshakalaka]

You didn't see that in medicine. In recent years, it is starting to creep in. From Opiod mill pills to botox parties I am seeing more physicians (often younger millennials in primary care specialties) that don't feel the financially secure and are looking to boost their income (often to contend with student loan payments).

It is an even larger problem in our field. We have seen the FSPS programs target forensics and neuropsychology as the moneymakers and try and produce more with the promise of big incomes. As it becomes harder to make good money with bread and butter treatment, I am sure more and more folks will be tempted to breach ethical lines to make a dollar. It happens a lot more in the mid level professions due to numbers, but the state of healthcare in the U.S. compared to things like tech will mean that more people will feel the financial pressure.

I wish I could quantify the increase in FSPS practitioners in the neuro and forensic realms. There seems to be a progression of Alliant/Argosy/Whatever mill >>>Unaccredited Internships>>>Buy Melton>>>Fielding Neuro Certificate>>>Amplify Social Media Presence>>>Forensic Neuropsychologist

It's an alarming trend. I'd be curious to see if others have noticed this. They also seem to promote each other, too.