There is a raging debate on the national npsych listserve (this happens every few years there) regarding the state and future viability of the profession. Although you really need to read the posts to understand all the issues and the true scope of its seriousness, the crux of the argument is that there is not enough research showing the medical value of what we do in order for our services to continue, in their current form, for much longer. The vast majority of the opinion seems to be that this is our own fault due to the fact that we have remained factionalized (eg., the "my board is better than your board" nonsense), have not lobbied nationally, have not produced many studies that demonstrate the cost-effectiveness of our services (although this may be because they dont exist or that effect sizes are too small to convince insurance companies), have not been able to restrict the practice of npsych by other providers, by and large have NOT embraced computerized technology in our assessment methods, have NOT been able to fight off the computer assessment programs that are marketed to neurologists and other MDs (eg., neurotrax, Mindsteam), continue to give 6-8 hour paper-pencil batteries that are ripe for scoring errors, take a month to get back the refferal source, and produce 10 page reports full of process-oriented musings that MDs and neurologists find obtuse and not very user-friendly. Whew that was alot! Embedded in all this is how this has significantly impacted the financial bottom line of many practitioners (one stating that her group practice now makes 2/3 of their revenue from therapy and psychopharm rather than npsych....3 years ago it was just the opposite). In fact, this is nothing new. The npsych list serve is always full of posts regarding how to bill for this or that, how to get a at least an 80% reimbursement from this or that insurance company, how this case and that case had to be written-off due to billing complications or flat out denial of the claim. In other words, insurance companies dont value us and dont like us! If these people don't think we have a necessary and valuable service to offer, we are going to disappear! At the moment, the only people I see who truly value npysch is US (psychologists and other neuropsychologists)...and a some (certainly not all) of our physician referral sources. Thats nice and all, but our referral sources aren't the ones making the reimbursement policies/decisions. I jumped ship on pursuing neuropsychology as a full-time career specialty a couple years ago due to this "writing on the wall" and the changing nature/attitude of healthcare, healthcare reimbursement, and the perceived blindness with which most practitioners approached these market issues. I don't think its all doom and gloom necessarily, but the issues ARE there and my npsych supervisors seemed blind to the fact that neuropsychology will be probably HAVE to change dramatically over the next 10-20 years. Instead, they practiced that way they were taught, 8 hour batteries, gave full WAISs to elderly demented patients, wrote insanely long reports that no one ever read, and seemed like they could care less if the information was actually utilized or impacted patient care/tx planning for the better (although I did have one practicum where npsych was embedded in a larger team and did indeed contribute to medical tx recommendations that were implemented). I found most of my neuropsych practicum experience to be an exercise in futile-ism.... and occasionally, intellectual masturbation about block-design placements. I'll let you in on a little secret, no one cares but you...and maybe some other neuropsychologist down the hall. The principle players in all this (docs, insurance companies) DO NOT. After all the set up, I suppose my actual question is for those younger grad students who are so eagerly going into the practice of professional neuropsychology. Are you aware of these issues? Do faculty or supervisors talk with you about these issues? Are you aware of how replaceable and undervalued your services are in many settings? Are you aware that unless you work in a VA or large academic hospital, the nature of your evals, services, and your billing expectations are going to have to change from what you were probably taught in your program and on your practicums? Are you aware that their is frightening little empirical research to even justify the cost-benefit ratio of your services? For everyone, what do you think the solution is? Massive lobbying? A massive research effort to demonstrate the utility of our services (is that even possible? Will our services even pass the cost-benefit test used in modern healthcare?)? A unification of the boards so we can advocate better/stronger? Restricting the practice of neuropsychology? Increasing the numbers of practicing of neuropsychologists (more numbers equals more power...look at the AMA)? My personal view is that the perfect storm has been brewing for years and that its a declining field. Well, at least a decline from the way we currently know, understand, and practice it in grad school. Am I wrong?