Why don't state psychological associations move to legally protect psyc testing?

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edieb

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Aside from Louisiana, in which psychological and neuropsychological testing is strongly protected, why don't more state psychological associaitons move to legally protect testing? As a profession, it seems like we are just waiting for scope creep to occur.. For those who are doing two year neuropsychology post-docs, doesn't this bother you?
 
Nothing to contribute. Just surprised my state is ahead of the game on something 😀
 
Aside from Louisiana, in which psychological and neuropsychological testing is strongly protected, why don't more state psychological associaitons move to legally protect testing? As a profession, it seems like we are just waiting for scope creep to occur.. For those who are doing two year neuropsychology post-docs, doesn't this bother you?

Yes, it is quite frustrating. I've been genuinely shocked at some of the reports and "interpretations" I've come across from non-psychologists. In an ideal world only fellowship trained neuropsychologists would be allowed to give neuropsychological assessments, but now we have all sorts of professions trying to do it.
 
Yes, it is quite frustrating. I've been genuinely shocked at some of the reports and "interpretations" I've come across from non-psychologists. In an ideal world only fellowship trained neuropsychologists would be allowed to give neuropsychological assessments, but now we have all sorts of professions trying to do it.
seriously? i sometimes wonder why individuals dont reject the creep....like, i know that there are a few neuropsych measures that i have been trained to administer, but would i proport to be a neuropsychologist or start doing neuropsych assessments? HELL NO! im not trained enough for that and i know it....i just dont get why other professionals cant have an accurate view of their training and capabilities. it really irks me.
 
It comes from within the field (generalists who decide to do "neuropsychology on the side"). It also comes from some physicians (neurologists, psychiatrists, etc) that feel like they can just pick it up after reading the instruction manual or some random journal articles. There are also some computer packages that offer "canned" reports, that are targeted at non-psychologists.
 
It comes from within the field (generalists who decide to do "neuropsychology on the side").

This was a real issue in the state where I did my undergrad, due to there being only one board-certified neuropsychologist in the state, who was also in academia and therefore only practiced part-time.
 
seriously? i sometimes wonder why individuals dont reject the creep....

Because most people probably don't know what it really takes to become competent at performing a neuropsychological evaluation. And that's not just lay people, that's people in the field too. As for me, I would support that being restricted to people who have the appropriate training. And I sure as heck know that that isn't me. I order it frequently, it would never occur to me to actually try to do it. 😀
 
If only some of your colleagues over there had the same humbleness about the limits of ones competence...

Fortunately, that seems to be a problem that is pretty infrequent out there. Most physicians I know recognize this and generally have little interest or patience for such things anyways. However, computer programs such as neurotrax and the like are gaining ground amongst neurologists in the outpatient office. Turn around time is quick and reports are to the point. We could definitely learn something from this. Nevertheless, I am actually more concerned about testing and assessment being misused within our own ranks than by others. Both personality and intellectual/cognitive assessment has long been a practice of the clinical psychologist and I would loathe to tell one they couldn't do it, but frankly, I am routinely disappointed by assessment reports from my colleagues who are not post-doctorally neuropsychologists or who who have substantial experience in the subfield.
 
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Psychologists are extremely poor at advocating for themselves and the profession. We are only good at hurting ourselves by creating more barriers towards licensure etc. APA has not done anything to restrict scope of practice as well. On the other hand, The american medical association lobbies hard to protect physicians and has restricted psychologists from generally obtaining prescription rights. The AMA has also restricted the number of medical schools so demand is high for physicians. I refuse to pay APA dues or support them anymore because i keep seeing that they fully accredit all the professional programs that admit 70 students.... our field is in need of leadership!

Why have psychologists not done anything to restrict other professions from practicing psychotherapy when they don't have the training, including nurses or psychiatrists?

Why have we not done anything to resolve the internship problem that started over 10 years ago?

Why have we let hospitals and for profit clinics get away with slave labor by having our graduate students work unpaid throughout graduate school? At least restrict the number of hours or require some sort of stipend.

Why have we not contested states that have irrational and overly cumbersome licensing procedures? For example, some states require post-docs to accrue 4 hours of supervision per week and require a ridiculous amount of hours to be face to face. They also require an oral exam, but this has a long wait and can impact ones' ability to start working. In some states, it takes 3 years to get licensed because of these insane requirements. Other states require extra course work that is not offered by any graduate program, such as elder care and child abuse and assessment. So you need to take additional coursework once you finish your doctorate.

It is very sad and demoralizing to be a psychologist these days.
 
Psychologists are extremely poor at advocating for themselves and the profession. We are only good at hurting ourselves by creating more barriers towards licensure etc. APA has not done anything to restrict scope of practice as well. On the other hand, The american medical association lobbies hard to protect physicians and has restricted psychologists from generally obtaining prescription rights. The AMA has also restricted the number of medical schools so demand is high for physicians. I refuse to pay APA dues or support them anymore because i keep seeing that they fully accredit all the professional programs that admit 70 students.... our field is in need of leadership!

Why have psychologists not done anything to restrict other professions from practicing psychotherapy when they don't have the training, including nurses or psychiatrists?

Why have we not done anything to resolve the internship problem that started over 10 years ago?

Why have we let hospitals and for profit clinics get away with slave labor by having our graduate students work unpaid throughout graduate school? At least restrict the number of hours or require some sort of stipend.

Why have we not contested states that have irrational and overly cumbersome licensing procedures? For example, some states require post-docs to accrue 4 hours of supervision per week and require a ridiculous amount of hours to be face to face. They also require an oral exam, but this has a long wait and can impact ones' ability to start working. In some states, it takes 3 years to get licensed because of these insane requirements. Other states require extra course work that is not offered by any graduate program, such as elder care and child abuse and assessment. So you need to take additional coursework once you finish your doctorate.

It is very sad and demoralizing to be a psychologist these days.

You are so right. I just received my license to practice from Washington state on Friday and instead of feeling happy for passing the EPPP and navigating the other requirements for my Ph.D. and then my license, I literally cried because of what I had done to myself. I even remembered one of my professors saying that if you want to work in an applied setting, get out now because it's too much effort for too little pay.

In the jurisprudence examination, there were 20 other people scheduled to take the test. All of them were from Argosy in Seattle. None of the ones whom I spoke to had even done an accredited internship and none were making decent money. Our field is fast becoming de-legitimized by these diploma mills with lax admissions standards in a way similar to the way psychiatry has with most psychiatrists graduating from non-U.S. medical schools. The only difference is that the numbers of psychiatrists are regulated and, therefore, they still command super high salaries.

In no other healthcare field will you go through SO much in terms of effort and time to get a degree and get SO little in return. I never thought that after all this would I still be in school (earning a post-doc in psychopharm so I can prescribe) and be so poor that I can't afford a sofa for my apartment's living room or a new car to replace the one I drove in graduate school. Unless I get married to a rich man, I will never be able to afford to live comfortably and have children. My sentiments are shared by others to whom I speak.

I come on this board and I can see people with sentiments that were so similar to me when I started out: money doesn't matter that much, let's get endless amounts of training for no reason, etc. Now I get out and obtain one of those vaunted V.A. jobs at which I will max out at $81,000 next year (except for very small increases in pay every year or two) while I see the psychiatrists making 3x the amount, doing less work, etc. It is very disheartening.

Even sadder is the fact that we could all turn this around if we put in some effort. There is a petition a couple of threads below that could possibly galvanize the APA into action regarding the internship debacle. There is another thread regarding a bill that could get us listed as independent providers for Medicaid.

Although I think the APA could do a better job, I think it is doing well overall given what they have to work with. What other organization has to deal with its own members suing it (the current class action lawsuit regarding the practice directorate) or its members speaking about efforts to expand our scope of practice? If people are so distressed about the direction of the field, join the organization and hold office to work and change things
 
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Edie,

I understand your frustration and you're overarching points about the profession are indeed correct. Its really NOT a good cost-benefit ratio from an economic perspective. And its our own fault, mostly.

However, I would just say that 81k is more enough than to live comfortably (but not luxuriously) in most areas of the country (outside CA and huge cities). Moreover, many many people who make significantly less have children everyday in this country. So, I don't think you should catastrophize so much. My wife (who makes a modest living as a school teacher) and I both have debt and we have already budgeted out how to buy a small starter house and send our kids to local catholic schools, all without going broke. This is all based on a projected combined income of slightly over 100k for next few years. We will not live the life of physicians though, thats for sure.
 
We definitely do not do ourselves any favors in regard to advocacy (or lackthereof), encroachment, or professional stability within and outside of the healthcare system. I'm glad I'm on the other side of graduate school, internship, etc....because it looks like it is getting worse. As a profession we need to do a much better job for advocating for our profession. If people want good examples, look at what our colleagues in medicine, nursing, and social work are doing in regard to lobbying. Psychology is an "also ran" on the Hill.

The more time I spend on the clinical side of things, the more I want to move up my "exit plan" from clinical work. There is still money to be made for the business savvy folks, but your completely average clinician taking an averag job will be working well into their retirement years because the 6-figure salaries are much harder to come by in today's market.
 
I would be more than happy with 81 K after graduate school....you were one of the few lucky ones to earn that much as a recent graduate. I know other who are making 40-50K while licensed as well or were unable to find a position. My ideal income would be about 100K, but i'm not sure how realistic that is on the clinical side of things....

I have already given up on having children or saving for retirement because my loans will be 800-1000 per month and i can't even imagine kids being an option for many of us. Right now i live on 25K and it really sucks! I can't go to routine medical check ups because my insurance does not cover most of the fee and i'm left with hundreds of dollars for a routine doctors visit. Did you know that a blood test costs $2,000 where I live? Physicians charge $300-400 for a 10 minute appointment in my area. CRAZY.
 
I would be more than happy with 81 K after graduate school....you were one of the few lucky ones to earn that much as a recent graduate. I know other who are making 40-50K while licensed as well or were unable to find a position. My ideal income would be about 100K, but i'm not sure how realistic that is on the clinical side of things....

There is quite a bit of variability in salaries. I know counseling centers typically do not pay well, though the university benefits tend to be quite good. Community Mental Health is another historically poorly compensated area. Contrast that with GS-scale positions (VA, armed services civilian, prisons, etc).

Formal post-docs can really vary. I've seen $15k-$25k, and I've also seen $40k-$50k+. Academic medicine is typically in the mid-30's to high-40's (with research positions often paying significantly more). I'm not really sure where informal post-docs fall, but it seems like mostly poor compensation.

Some people have jumped into a gov't job after their post-doc year(s), and they have been able to get a GS-13 position, though that is harder to do. I'd consider this the exception and not the rule. Raliegh, NC is $85k for a GS-13, and $71.5k for a GS-12....not bad. Others really struggle to land any position. I'm in a 2-yr fellowship, and GS-13 or similar is what I'm expecting. $100k+ is very doable with a few a couple of assessment cases on the side each month. I also know people who make $50k and put in 25-30+hr of direct therapy each week.
 
However, I would just say that 81k is more enough than to live comfortably (but not luxuriously) in most areas of the country (outside CA and huge cities). Moreover, many many people who make significantly less have children everyday in this country. So, I don't think you should catastrophize so much. My wife (who makes a modest living as a school teacher) and I both have debt and we have already budgeted out how to buy a small starter house and send our kids to local catholic schools, all without going broke. This is all based on a projected combined income of slightly over 100k for next few years. We will not live the life of physicians though, thats for sure.

Agreed. I live quite comfortably in a downtown apartment in a decent-sized western metropolitan area. My fiance and I currently have a combined income of less than $50k (we're both in school). One of my supervisors, a neuropsychologist, makes ~90k at a public hospital and supports a family of four. Right out of my posdoc, with my wife's earnings, I expect that we'll pull in ~$150k on the low end. Given how comfortably we live now on less than 1/3 of that, I have little concern.
 
Oh good, thanks guys. I was freaking out after that post.
 
I'm often confused by people's perceptions of what is necessary to "live" from folks here. Certainly we are not going to be rich. Anyone who went into this field expecting to be didn't do their homework. Yes, pay is pretty crummy compared to the amount of education we receive - if I followed my original trajectory (financial sector/corporate law) I likely would already be earning far more than I will make at the end of my career, with far less schooling. Heck, even if I skipped law and just went straight finance I could likely do better with a bachelor's than I will with a doctorate. I fully agree that through proper advocacy and concerted effort, we can do better. I fully agree that collectively, we've kinda sucked at that as a profession.

However, last I checked the median household income in the US was around 50k. Since the vast majority of households are dual income these days, that means the average individual is earning much less. People still raise children, own homes, feed themselves, etc.

I'm not saying we can't improve things or shouldn't try. I do think its a little worse in clinical sectors than research (or so I've heard). However, I do think we should avoid being completely disingenuous. Once I finish post-doc, my starting salary will likely be comparable to or higher than my parents combined salary (admittedly I'll be in research, but the difference doesn't seem to be that drastic). We weren't "poor" growing up by any stretch of the imagination.
I think if we're going to advocate, it needs to be an honest discussion. Those of us in university programs will likely have reasonable/minimal debt - if we talk about how we can't survive on those salaries, its going to make us look like spoiled brats, which is not going to sway those with the power to make decisions. We have perfectly legitimate arguments to make (salary relative to others with comparable education, cost burden of mental health illness relative to other areas of healthcare, increasing evidence of the cost-effectiveness of interventions - though this area HAS been sorely lacking for a long time).
 
80K is not a realistic salary for many clinical psychologists these days from what i'm seeing if you want to do clinical work. APA posts the median salary for clinical psychologists with a doctoral degree as 85K. However, the average number of years of work experience for these folks are 20 years and they are all APA members, a skewed sample. Plus, only 26% respond to the survey. My personal experiences from talking to many graduates has been very different, particularly for recent graduates in this economy.

I noticed that people who respond to this forum are typically at VA's or research oriented medical centers or neuropsychologists. I think you guys are on the very high end of the salary range for psychologists since VA positions are the highest paying for psychologists. Please try to understand that these jobs are very hard to get and do not represent the majority of clinical psychologists.

I live in a expensive big city and starting salaries for clinical work (some post-doc, some not) are around 15-35K talking to people who graduated from my program. I have seen positions that are unpaid and ones that pay 15k, and yes they get filled!
 
Sorry, but I have to seriously doubt that there is a full-time position specifically marketed to doctoral psychologists for 15k. The lowest paying post-doc I have EVER seen is 19k and change.

I think an easy way to solve a problem like that is to just NOT take the job. It would be ludicirous anyway since one can make almost twice that waiting tables, tending bar, or working at The Gap for that matter. If you're that desperate for money, take one of those to tide you over. I also think many of us would add that if your competing for jobs that are also interviewing MSWs for your position, you're not utilizing your training optimally or marketing yourself optimallly.
 
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However, last I checked the median household income in the US was around 50k. Since the vast majority of households are dual income these days, that means the average individual is earning much less. People still raise children, own homes, feed themselves, etc.

Ollie, your're not understanding your audience very well. How many people who pursued their Ph.D in clinical have fantasized about, or are OK with, being "average." I, am not. Most of us went this route because we have always been "above average" in our endevaors. My wife grew up being relatively lower-middle class. However, I dont thinks he dreamed of being just "average" either.
 
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I tell people that as well, but not many people want to hear it. 🙄
 
The median of 50K is fair considering that only 26% of people in this country even went to college (you can look up the percentage online). This is made up mostly of people who never went to college or graduated from HS.

Plus, the median is poverty level for living anywhere on the east or west coast (nearby a city). I don't feel that i should be willing to move ANYWHERE since many of us are married etc and have spouses who are restricted to a certain location.

I don't feel entitled to be guaranteed an income, but after 5-7 years of graduate school at a top program, i don't want to live in poverty as I have been while in graduate school (not being able to afford health insurance even through my university, and trying to live on 20K in a big city). I don't have financial support from family or a spouse, so living in poverty is a very realistic fear of mine. Even 30K out of graduate school will not allow me to live decently b/c i have some loans from college and graduate school (i didn't take out all loans in graduate school, but some).

I also know several people who had to move back in with parents after graduate school because their jobs did not pay enough to rent an apartment on their own. I do not have this option of moving back in with my parents. So yes, these fears are realistic and some people live in poverty for several years at least after graduating. 25-30K in NYC or California is pretty rough with loans.
 
Yes, i agree that I live in a saturated area, but i can't just easily move and start over. This is not a sacrifice i'm able to make. Plus, I don't think psychologists do so well in the midwest or southern states either. I'd rather switch fields than move constantly.
 
John Snow:

Its easy to sum everything up to bad decisions instead of looking at systemic problems in the field as a whole. Which bad decision did I make exactly? Going to very solid clinical psychology graduate program? I'm not in a diploma mill graduate program, but a university based program with a good reputation. Taking out some loans for college while earning money working part-time to pay for the rest? Studying something that I'm actually passionate about instead of going to medical school?

The median amount of loans for clinical psychology graduate students these days is $77,000. Did we all make bad decisions then because i'm certainly not above the median?

I'm not interested or inclined to pursue a career in research. Those of us graduating in the clinical field these days are facing much more limited job prospects than even a couple of years ago and salaries are very depressed.
 
I am fairly flexible with job stuff. I'm very willing to do general assessments even though that is not my passion. However, I'm really interested in being a neuropsychologist or do forensic evaluations. Its simply not at all in my interest area. If I was going to do something for a secure income, then i might as well go into finance because neuropsychology is pretty far from my interests.
 
If they lack adequate marketing and business savvy, I would imagine it would be pretty tough. But I don't really see that as a failing of the field.

Well, to be fair, many have argued that it does indeed fall at the feet of the doctoral program. Sending out a horde of people who will be running a business (whether its a PP or a clinic within a hopsital) without any talk or training on such matters in the doctoral program seems quite irresponnsible to me.
 
Like I said, I agree that if you're applying to a place where they are interviewing MSWs or MFTs for your position as well...then you're doing something wrong. You're not utilizing the diversity of your skill set...you're not marketing yourself well. But, it has always struck me how "out of it" academic programs seem to be when it comes to this economic side of this profession. Are they really so scared to acknowledge the fact that they are creating business owners. Even the person who runs the big research university medical center outpatient clinic has to justify keeping the lights on. There's a business/economic component to almost every job we do in this field.
 
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I got a bit soapbox-ish in my post. My response isn't directed at anyone, I just quoted erg923's post because it was a great example of what is frustrating me about this whole mess.

Like I said, I agree that if you're applying to a place where they are interviewing MSWs or MFTs for your position as well...then you're doing something wrong.

This is a HUGE part of the problem, there are doctorally-trained clinicians taking jobs that any licensed clinician can do. People argue that, "a job is better than no job", but in this case that is not true. Allowing yourself to be had for a fraction of the cost is screwing yourself AND screwing the field.

If the economics are really that bad....work in another field. I'm tired of hearing people complain about the market, and then hear that they have done NOTHING TO CHANGE IT. Why aren't you lobbying at your local state house? Why are you not calling/e-mailing/etc. the APA to voice your opinion? Why are you accepting companies to take advantage of you? Have you even tried to educate a potential employee about why you deserve to be paid a salary that is commiserate with your training? Have you explored clinically-related jobs that don't require a doctorate, but they pay $50k+? Compared to the "average" person out there, you are incredibly well educated, it is time to act like it.

We have poor leadership in our field that historically has been a weak to non-existant presence on The Hill. The blame is not solely on their shoulders, as they have a fraction of the $ that other associations have because psychologists are cheap and apathetic when it comes to legislative action. The outcry comes after the fact when more of our domain is lost to lesser-trained professionals. At some point you need to be more accountable for your non-action. There are a host of things you CAN do if this really was an issue you cared about. Inaction because people aren't there to do it for you is not an excuse.

How many people can honestly say they have talked to a local/state representative about the value of psychology or about possible legislation that impacts our field? How many people have given $ to a political action committee that supports our causes?* How many people have done education out in the community to promote psychology? How many people have spoken to colleagues in related fields (medicine, nursing, education, etc) about what we can offer?

I'm guessing a very very small percentage of people can say they have done any of the above. I've done them all, but not nearly as much as I probably should. We are not dumb people and we should not need someone to hold our hand to get us involved. What are you doing to help our profession?

*edited to add* If people are interested in becoming advocates for our profession, I'm putting together a few articles on the topic. I started it with the intention of shopping it to APAGS or similar, but I may just post them up on the web.**

*Willingly...the "extra" practice fee that the APA does not count because you didn't even know that was an optional fee.
 
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Yeah, I don't really know what the standard is across the board for graduate programs in terms of teaching this. However, I would argue that this information is probably still accessible in graduate school, even if it's not explicitly taught (e.g., asking professors or clinical supervisors that have experience with private practice, etc.).

In my graduate program, we did get some of this instruction and we have had several seminars relating to starting a private practice during my internship year. The institution where I will be doing my postdoc offers practical seminars like this (although granted, more research-related than private practice-related).

Unfortunately, most programs do not have formal or even informal resources to address many of these things. I've lectured before on some of these topics, and the most common feedback I've gotten was, "No one ever talked to us about ANY of this." The student/early career psychologist really needs to seek out mentorship if they want to be successful.

You may have to look to other departments to learn the nuts and bolts of things like accounting, how to write a business plan, etc. You may need to network outside of your job. I am signed up for all sorts of e-mail lists for my university/hospital to make sure I know about events (almost always free). Just in the last 6 months I've attended talks/presentations/seminars given by the Business School, Medical School, Life Sciences, Law School, Tech Transfer Office, Research Office, Postdoc Office, and similar. Not all of it applies, but I feel like it was time well spent because I now know where to look and who to ask when I have questions.

You can't stay in your bubble. As a graduate student you have carte blanche to e-mail people and ask for advice, just use some tact. I use my "fellow" title to pick the brains of some of the brightest people in my town. A little bit of interest and leg work can go a long way. You just need to find the time. I work a lot of 12+ hour days because I take time at lunch to catch a speaker, maybe a couple hours in the afternoon to go meet with a faculty member in another dept, etc. I know my hospital's administrators, business leaders in my city, I'm starting to meet local politicians, etc. It isn't easy, but it can make all the difference in the world.
 
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Ollie, your're not understanding your audience very well. How many people who pursued their Ph.D in clinical have fantasized about, or are OK with, being "average." I, am not. Most of us went this route because we have always been "above average" in our endevaors. My wife grew up being relatively lower-middle class. However, I dont thinks he dreamed of being just "average" either.

And this is a totally fair point. Given the education we should be earning above-average income. Actually, I suspect that we still are substantially above "average", but that wasn't really my point.

I was just saying that it seems outlandish to talk about not being able to afford basic necessities if we are earning more than the average household. I'm not by any means saying our compensation is appropriate or that people shouldn't be complaining about it - compensation is low, and we absolutely should be fighting for more. I just don't think we're going to make a believable argument if we act like even 30k a year = starving in the streets. If I were a legislator, I'd just refer that person to a community ed class on very basic financial skills and budgeting. We have more convincing arguments to make, and should focus on those.
 
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Unfortunately, most programs do not have formal or even informal resources to address many of these things. I've lectured before on some of these topics, and the most common feedback I've gotten was, "No one ever talked to us about ANY of this." The student/early career psychologist really needs to seek out mentorship if they want to be successful.

You may have to look to other departments to learn the nuts and bolts of things like accounting, how to write a business plan, etc. You may need to network outside of your job. I am signed up for all sorts of e-mail lists for my university/hospital to make sure I know about events (almost always free). Just in the last 6 months I've attended talks/presentations/seminars given by the Business School, Medical School, Life Sciences, Law School, Tech Transfer Office, Research Office, Postdoc Office, and similar. Not all of it applies, but I feel like it was time well spent because I now know where to look and who to ask when I have questions. You can't stay in your bubble. As a graduate student you have carte blanche to e-mail people and ask for advice. I use my "fellow" title to pick the brains of some of the brightest people in my town. A little bit of interest and leg work can go a long way. You just need to find the time. I work a lot of 12+ hour days because I take time at lunch to catch a speaker, maybe a couple hours in the afternoon to go meet with a faculty member in another dept, etc. I know my hospital's administrators, business leaders in my city, I'm starting to meet local politicians, etc. It isn't easy, but it can make all the difference in the world.


Yea well, the AMA has more money because they have many, many more members than the APA does. There are just many more medical practitioners in this country than psychologists. There is also less fractionalization within the medcial community. APS seem like it makes a little bit more sense to me but I cant help to think that it would look better if we presented a united front.
 
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