PhD/PsyD Solution to the Turf War?

[PsychMajorUndergrad18]

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Hello Everyone,

I have seen soooo many threads that address the turf war going on between doctoral level psychologists and master-level providers and was just wondering if anyone had any ideas they have to handle this problem going on in the mental health provider community?

My idea would be to clearly divide the responsibilities and limits of each profession while also promoting a collaborative approach. Kinda like how doctors and PAs work together. So have the masters level therapists handle therapy while the psychologists supervise the therapist, handle all administrative duties for the practice or department and also do assessment.

And another idea is to promote more psychologists in mainstream medicine. Like for example, have psychologist do psych evals for people who are complaining of chest pain or other chest related symptoms to rule out anxiety attacks or a anxiety disorder.

Again these are just my ideas and I would love to have you all critique them, add onto them, propose completely different ideas or have a valid argument of why we should keep things the way it currently is.

Looking forward to hear from you all,
PsychMajorUndergrad18

 

[erg923]

Hello Everyone,

I have seen soooo many threads that address the turf war going on between doctoral level psychologists and master-level providers and was just wondering if anyone had any ideas they have to handle this problem going on in the mental health provider community?

My idea would be to clearly divide the responsibilities and limits of each profession while also promoting a collaborative approach. Kinda like how doctors and PAs work together. So have the masters level therapists handle therapy while the psychologists supervise the therapist, handle all administrative duties for the practice or department and also do assessment.

And another idea is to promote more psychologists in mainstream medicine. Like for example, have psychologist do psych evals for people who are complaining of chest pain or other chest related symptoms to rule out anxiety attacks or a anxiety disorder.

Again these are just my ideas and I would love to have you all critique them, add onto them, propose completely different ideas or have a valid argument of why we should keep things the way it currently is.

Looking forward to hear from you all,
PsychMajorUndergrad18

I'm not sure this is an actual thing in day to day practice. There is a scope of practice, and by and large, I think people stick to it. Masters level providers who are practicing have their own license and do not need supervision. I would agree that psychologists can add, and often do, serve in educational and administrative roles.

Btw, anxiety would be the default conclusion after medical factors are ruled out. If someone is complaining of chest pain, they need an ER and cardiac workups. Psych comes later. Psych is also already in primary care. I am one of them

 

[psych844]

Kinda like how doctors and PAs work together.

I think you're painting a rosy picture here. M.D's are pretty frustrated with the encroachment from mid-level providers (Nurse Practitioners and Physician Assistants). In some areas there is even a push to give Pharmacists an ability to prescribe more medications. PA's are pretty new thing in Canada but they aren't really doing a different job or serving a "new" role. They do what MD's do (their scope is almost the same) but they generally deal with patients that come in walking, as opposed to really critical patients. They also have to be supervised by an MD..but that isn't different than Residents having to be supervised by an Attending.

I don't really even see much issue with Masters level Psychologists (as long as there are restrictions..maybe an inability to diagnose without additional training, trained at good schools, etc)

The main problems I see are for-profit schools and professional schools...they provide poor training, they increase supply unnaturally, etc And second, Clinical Psychology doesn't have the money of the medical lobby to really ingrain ourselves more into society. Everyone seems to agree that Mental health is important..but i'm not sure if Psychologists are utilized in as many contexts (or as much) as Psychiatrists.

 

[Therapist4Chnge]

I think you're painting a rosy picture here. M.D's are pretty frustrated with the encroachment from mid-level providers (Nurse Practitioners and Physician Assistants).

Agreed. Moreso w. NPs (particularly in Gas and NPs elsewhere Rx'ing completely independently).

I don't really even see much issue with Masters level Psychologists (as long as there are restrictions..maybe an inability to diagnose without additional training, trained at good schools, etc)

For as much as I agreed with the encroachment idea, that's how much I disagree with this idea.

Psychologists should beat the doctoral level, period. No exception. I know some ppl are grandfathered in, but hopefully all of the loopholes can be closed.

 

[psych844]

For as much as I agreed with the encroachment idea, that's how much I disagree with this idea.

Yeah, I don't disagree with you in theory. Phd standard makes sense, as it allows for someone to be sufficiently trained in both clinical skills and research skills. A Psychologist without a strong research background (or at least emphasized as much as clinical) shouldn't be called a Psychologist.

But you have to understand my perspective. I'm in Canada, a country that doesn't have one professional or for-profit school that is accredited, and we do have quite a few provinces that allow Masters-level Psychologists. (but with limitations in most provinces). In Saskatchewan Masters level Psych cannot give a diagnosis. In Nova Scotia, your degree can't be online. These Masters level people are also restricted by how much experience and training they had, (Masters programs are 2 or 3 yrs), and by their ethics.

But I'd rather have that..give the title of Psychologist to some Master level people, but ensure these people have a) gone to good schools b) have limitations... than.. have a Phd standard..but have horrible diploma mills with horrible training..which ultimately allows someone to have a Dr. in-front of their name, just like I do, and have the same rights and privileges as me, but not be fit to run the water for a bath. That does a lot more damage to the field imo.

 

[deleted343839]

My idea would be to clearly divide the responsibilities and limits of each profession while also promoting a collaborative approach. So have the masters level therapists handle therapy while the psychologists supervise the therapist, handle all administrative duties for the practice or department and also do assessment.

I think most people are in favor of clear roles and responsibilities. The problem is that not everyone agrees on those roles, and doctoral-level professionals have legitimate reasons to be concerned about "scope creep."

So have the masters level therapists handle therapy while the psychologists supervise the therapist, handle all administrative duties for the practice or department and also do assessment.

I don't think it's that clear cut, though. We can't assume this will result in appropriate patient care. Let's say your practice has a new patient with PTSD who would probably benefit from an empirically supported treatment approach that you're familiar with, but none of the master's level therapists in your practice are competent to provide (not an unlikely scenario). You can't - or at least shouldn't - supervise your way through a course of CPT or PE with someone who has no supervised experience in these treatments and who knows little about the empirical basis of the intervention. So is your solution to refer out and lose the patient, or settle for supportive therapy (less than optimal care)? My point is that there will be situations that call for a psychologist's expertise in intervention. It's not to say that no master's level clinician can learn to manage these cases, just that it is less likely given the depth and breadth of their training versus the training of a psychologist.

I also think that in emerging areas of practice, or areas in which there is not a strong evidence base to support intervention strategies, the expertise and scientific orientation of a psychologist is essential.

 

[erg923]

You can't - or at least shouldn't - supervise your way through a course of CPT or PE with someone who has no supervised experience in these treatments and who knows little about the empirical basis of the intervention.

The VA does this a hundred times over year after year. Hey, if its an "EBT" it must be the bees knees...and anyone who sees patients can do it.

 

[erg923]

Although somewhat tangential/irrelevant, I will say that my success rate for getting patients to accept referral/consult for a trauma focused EBT is about.....30%, at best (I can't do this in primary care, and I am hesitant to embrace this new 3-4 session PE thing i have been hearing about). Most of these people have been like this for years now, even though OEF/OIF guys at this point, have been medicated out the ass, and the avoidance and fear is STRONG.

Oh, and many of them lose a **** load of (tax free) money if they get better. Awesome.

 

[psych844]

Oh, and many of them lose a **** load of (tax free) money if they get better. Awesome.

The incentive system is f'ed up + Newton's first law seems relevant (an object at rest stays at rest and wants to be at rest..unless there is a force to accelerate it and change the equilibrium). People are use to a certain life style, certain habits, and it's hard to change.

I think the type of treatment that works the best for these kind of people is very behavior oriented. Less information and more practical advice/behaviors that they can do to improve and change their life.

 

[erg923]

I think the type of treatment that works the best for these kind of people is very behavior oriented. Less information and more practical advice/behaviors that they can do to improve and change their life.

Depends.

Information/psychoeducation and understanding the rationale for the treatment being administered is exceedingly important.

CPT, which has no mandated exposures or lifestyle changes necessarily, can be to be more appropriate (and an easier buy-in) for individuals with multiple traumas and/or those that involve profound moral or existential injury.

 

[smalltownpsych]

Our hospital administrator said the other that if you turned over a rock in this town you could find an LPC. Online degrees and easy licensure requirements lead to that. Nevertheless, my schedule remains packed with people that have a variety of reasons not to go them. I think the most important thing is to protect our title as psychologists and maintain our standards of training and expertise. We can't stop anyone from doing therapy, but we can promote ourselves as the experts that we are.

 

[PsyDr]

If any politician wanted to fix any disability system, they would create a tiered level of disability consistent with the Ana's guidelines to permanent disability (as opposed to ssdi's all or nothing), require the disabled person to attend a level of care commiserate with their level of disability (e.g., 100% from dementia= snf residence, or attendance to pt), associate the various legal systems so that individuals' liberties are protected in a manner consistent with their level of disability (e.g., guardianship), require ebt (I.e., follow ebt for opiates), put objective measures above subjective complaints, enforce criminal charges for malingering in a manner consistent with case law, and review each case according to the outcome literature.

Or they could just pay a living wage so that disability is not an attractive option.