Status of Psychology Clinical Neuropsychology in the USA

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Status of Psychology & Clinical Neuropsychology in the USA n Antonio E. Puente Universidad

Status of Psychology & Clinical Neuropsychology in the USA n Antonio E. Puente Universidad de Jaen Mayo 31, 2002

Outline of Presentation n n APA at a Glance Clinical Neuropsychology in Detail Perspectives

Outline of Presentation n n APA at a Glance Clinical Neuropsychology in Detail Perspectives of Clinical Practice Future Concerns & Directions

APA Membership Year Doctorate Masters Bachelors 1970 1505 457 2975 2183 1980 1921 1333

APA Membership Year Doctorate Masters Bachelors 1970 1505 457 2975 2183 1980 1921 1333 4096 5812 15440 26653 1990 1566 2245 3377 7353 15336 38616 1405 2905 3552 10913 17402 56600 19077 14602 2000

APA Membership by Division n Approximately 150, 000 members Approximately 50 different divisions Top

APA Membership by Division n Approximately 150, 000 members Approximately 50 different divisions Top three divisions are: n n n Clinical Psychology Clinical Neuropsychology Independent Practice

What is Clinical Neuropsychology? n n n Study and practrice of the relationship between

What is Clinical Neuropsychology? n n n Study and practrice of the relationship between brain and behavior, especially in neurological patients Approximately 4 -5, 000 Doctorate with post-doctorate training is minimum requirement

Survey of Clinical Neuropsychology n n National Academy of Neuropsychology Division of Clinical Neuropsychology

Survey of Clinical Neuropsychology n n National Academy of Neuropsychology Division of Clinical Neuropsychology of the APA Surveyors: Jerry Sweet & Ted Peck Date: 2001 -2002

Survey Return Rates Actual Return Rate n 1569 returns n 5791 mailed 1569/5791 =

Survey Return Rates Actual Return Rate n 1569 returns n 5791 mailed 1569/5791 = 27. 1% Adjusted Return Rate n Or returns, 1406 U. S. , Doctoral, Licensed, Clinicians n Of mailed, 1590 excluded (duplicates, unintended, undelivered) 1406/4201 = 33. 5%

Organizational Membership (All Doctoral Licensed Clinicians) Percent

Organizational Membership (All Doctoral Licensed Clinicians) Percent

Gender (All Doctoral Licensed Clinicians vs. Younger Samples) Percent Age: Males = 48. 6

Gender (All Doctoral Licensed Clinicians vs. Younger Samples) Percent Age: Males = 48. 6 (n=866) Females = 45. 5 (n=524) Years Since Licensed: Males = 14. 6 (n=855); Females = 10. 1 (n=508) -----------------Among licensed <10 years: (n=525) Males = 48. 6% Females = 51. 4% Among licensed <5 years: (n=216) Males = 36. 6% Females = 63. 4%

Type of Doctoral Degree (All Doctoral Licensed Clinicians) Percent

Type of Doctoral Degree (All Doctoral Licensed Clinicians) Percent

Field of Doctoral Degree (All Doctoral Licensed Clinicians) Percent

Field of Doctoral Degree (All Doctoral Licensed Clinicians) Percent

Work Status (All Doctoral Licensed Clinicians) Percent

Work Status (All Doctoral Licensed Clinicians) Percent

Work Setting (All Doctoral Licensed Clinicians) Percent

Work Setting (All Doctoral Licensed Clinicians) Percent

Gender Within Work Setting (Doctoral Licensed Clinicians) Percent

Gender Within Work Setting (Doctoral Licensed Clinicians) Percent

Board Certification Status (Doctoral Licensed Clinicians) Percent

Board Certification Status (Doctoral Licensed Clinicians) Percent

Organization (All Doctoral Licensed Clinicians, exc. Part time) Percent

Organization (All Doctoral Licensed Clinicians, exc. Part time) Percent

Organization (% for All Doctoral Licensed Clinicians, exc. Part time) Percent

Organization (% for All Doctoral Licensed Clinicians, exc. Part time) Percent

Sources (For All Doctoral Licensed Clinicians)

Sources (For All Doctoral Licensed Clinicians)

Incomes by Organization (Doctoral Licensed Clinicians Working Full Time or Full Time+) $

Incomes by Organization (Doctoral Licensed Clinicians Working Full Time or Full Time+) $

(Rational selection; Full time and Full time +) n n n Years licensed. 27**

(Rational selection; Full time and Full time +) n n n Years licensed. 27** Work Setting -. 25** % Forensic. 24** Gender -. 21** % Self Pay. 19** Age. 18** n n n Hrs billed/Eval. 13** % Public Aid -. 12** % Medicare -. 09* % Man. Care -. 09* % Indemnity. 07 % Indigent -. 04 *=. 05 **=. 01 Negative correlations in red. “Work Setting” above limited to Private and Institution All ns between 775 and 1185

Licensure (Licensed Doctoral Working Full time or Full time+) Stratification - Mean (Median) ‘Starting’

Licensure (Licensed Doctoral Working Full time or Full time+) Stratification - Mean (Median) ‘Starting’ Salaries - Mean (Median)

Income by Work Setting (Doctoral Licensed Clinicians Working Full Time or Full Time+)

Income by Work Setting (Doctoral Licensed Clinicians Working Full Time or Full Time+)

Income by Gender (Doctoral Licensed Clinicians Working Full Time or Full Time+)

Income by Gender (Doctoral Licensed Clinicians Working Full Time or Full Time+)

5 Years (Doctoral Licensed Clinicians Working Full Time or Full Time+)

5 Years (Doctoral Licensed Clinicians Working Full Time or Full Time+)

Activity (Full-time and Full-time plus Doctoral Licensed Clinicians)

Activity (Full-time and Full-time plus Doctoral Licensed Clinicians)

Evaluation Time by Evaluation Goal (Hrs. for All Doctoral Licensed Clinicians; 5 th &

Evaluation Time by Evaluation Goal (Hrs. for All Doctoral Licensed Clinicians; 5 th & 95 th%ile in parens. ) (Except forensic, those using assistants test more hours (e. g. , for determination of diagnosis, 6. 6 hrs vs. 5. 8 hrs, p=. 017. ) However, hours billed are similar.

Time-Related Case Activities (All Doctoral Licensed Clinicians) Minutes Hours billed: Private=11. 1 (SD=5. 0);

Time-Related Case Activities (All Doctoral Licensed Clinicians) Minutes Hours billed: Private=11. 1 (SD=5. 0); Institution=8. 2 (SD=3. 3) * Only scoring is not significant between groups; covarying amount of forensic practice did not eradicate group differences

Use of Testing Assistants (All Doctoral Licensed Clinicians) Percent

Use of Testing Assistants (All Doctoral Licensed Clinicians) Percent

Use Of Testing Assistants By Work Setting Percent Using Assistants (n=1349)

Use Of Testing Assistants By Work Setting Percent Using Assistants (n=1349)

CPT Codes Used For Neuropsych Assessment Activities (Doctoral Level Clinicians) CPT Code for Activities

CPT Codes Used For Neuropsych Assessment Activities (Doctoral Level Clinicians) CPT Code for Activities Intake Interview 90801 96117 96115 Other (16 codes) Clinical interview/history 90801 96117 96115 Other (20 codes) Test administration 96117 96100 96115 Other (12 codes) Frequency Percent 231 106 40 21 250 180 59 34 498 37 9 21 16. 5 7. 6 2. 9 1. 5 17. 9 12. 9 4. 2 2. 4 35. 7 2. 7 0. 6 1. 5

CPT: Applicable Codes n n n Total Possible Codes = 7, 500 Possible Codes

CPT: Applicable Codes n n n Total Possible Codes = 7, 500 Possible Codes for Psychology = Approximately 40 to 60 Sections = Five Separate Sections n n n Psychiatry Biofeedback Central Nervous Assessment Physical Medicine & Rehabilitation Health & Behavior Assessment & Management

CPT: Background l. American Medical Association –Developed by Surgeons (& Physicians) in 1966 for

CPT: Background l. American Medical Association –Developed by Surgeons (& Physicians) in 1966 for Billing Purposes – 7, 500 Discrete Codes l. HCFA/CMS –AMA Under License with CMS –CMS Now Provides Active Input into CPT l. Congress –Trent Lott (2001)

Current Problems l. Definition of Physician l. Supervision l. Face-to-Face l. Time l. RVUs

Current Problems l. Definition of Physician l. Supervision l. Face-to-Face l. Time l. RVUs l. Qualification of Technicians l. Payment l. Focus for Fraud & Abuse

Potential Solution l. Better Understanding & Application of CPT l. More Involvement in Billing

Potential Solution l. Better Understanding & Application of CPT l. More Involvement in Billing l. Comprehensive Understanding of Pay Sources l. More Representation l. National & Local Interest Groups

Predictions for Future l. Income –Steadier (if economy does not further erode) –Probable incremental

Predictions for Future l. Income –Steadier (if economy does not further erode) –Probable incremental declines, up to 10 -20% –“Final” stabilization by 2005 l. Recognition –Physician Level –Mental vs. Physical Health l. Paradigms –Industrial vs. Boutique –Health vs. Non-Health

Future Problems l. What Will be Future of Training Programs? l. Health Care vs.

Future Problems l. What Will be Future of Training Programs? l. Health Care vs. ? –Who will take care of “mental health” patients? –Will “mental health” & psychotherapy be MS level? –What about prescription privileges? l. Boutique Health Care as Income Protection?

Initial Results of APA Survey n Procedure n n n Five Year Review of

Initial Results of APA Survey n Procedure n n n Five Year Review of Status of APA & Psychology Random Survey of APA Membership, Staff, & Governance Results n n n Public Image of Psychology Protecting & Expanding Sources of Income Membership Concerns

What About Our Students n n Sex Differences Competition from Classically Well. Defined Professions

What About Our Students n n Sex Differences Competition from Classically Well. Defined Professions (e. g. , medicine) Limited Scientific Base Attitudinal-Personality Traits

Summary n n Continued Growth Especially in the Clinical Domains Expansion Beyond Mental Health,

Summary n n Continued Growth Especially in the Clinical Domains Expansion Beyond Mental Health, to Other Areas Vibrant and Unpredictable yet Exciting

Defining the Future… l. New Paradigm = Change l. Be Prepared l. Contribute l.

Defining the Future… l. New Paradigm = Change l. Be Prepared l. Contribute l. Enjoy