Psychologist supply, managed care, and the effects of income: Fault lines beneath California psychologists.

Data from the 2000 Calffornia Survey of Psychological Practice (D. Pingitore, R. Scheffler, M. Haley, T. Sentell, & D. Schwalm, 2001) were used to measure psychologists' income variation associated with demographic characteristics, managed care participation rate, and mental health workforce supply concentrations. A 10% increase in the supply of psychologists in a psychologists' market of practice resulted in a $1,749 reduction in income compared with a $1,330 income reduction due to a 10% increase in managed care participation. The authors discuss how psychologists' income and other aspects of practice are shaped by market dynamics, trends in the psychologist workforce, and public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional psychology in a new era: Practice-based evidence from California.

The California Survey of Psychological Practice provides comprehensive data on patient case mix, treatments, practice settings, and payment sources using a representative sample of psychologists. These psychologists practice in diverse settings and continue to deliver traditional psychotherapies. California psychologists' treatment of persons with private insurance highlights the profession's public health contribution by improving the functioning of employed persons and their families. Despite high managed care enrollment among Californians, these psychologists demonstrate wide variability in managed care participation. The authors compare the findings to prior surveys among psychologists and discuss the findings in relation to trends in psychological practice and public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New Jersey psychologists' report on managed mental health care.

New Jersey psychologists reported rankings of concerns encountered in their work with 10 of the state's managed care companies, and the authors propose a treatment concern cluster. Findings revealed that managed care negatively affects income and practice patterns, including pressure to change quality of care and compromise ethics. Degree of involvement in managed care differentially affected psychologists' responses. Not all managed care companies appeared equally problematic. Implications for clinical practice and public policy are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuity of care is the key.

Comments on D. W. Van Liere's (1978) response to the article by J. C. Matarazzo et al (see record 1978-32394-001) on psychologists' membership on the staff of university teaching hospitals, and argues that to provide continuity of care psychologists need to be full staff members of hospitals. The author suggests that psychologists should encourage hospitals to change, and should support the AAP in their suit against the Joint Commission on Accreditation of Hospitals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Care, National Health Insurance, and Psychology.

The role of psychologists as health care providers and the parameters of reimbursement for health care services are timely and controversial issues. A landmark decision was reached in this controversy in the 1980 appeal of a Virginia suit by clinical psychologists in which the court ruled that Blue Shield's refusal to directly reimburse psychologists was a violation of antitrust law. Thus, the requirement that psychologists bill through physicians was not upheld. In recent years a specific aspect of this controversy involved psychologists' roles in potential national health insurance programs. A limited study (appearing in the "National Register of Health Services Providers in Psychology" 1976-1978) of clinical psychologists' attitudes toward national health insurance suggests that Congress and psychologists may have disparate views. In addition to favoring national health insurance, over 85% of psychologists surveyed responded that consumers would benefit from such a program with mental health coverage. Only 16% agreed that such a program would constitute a subsidy of the rich by the poor (Albee, 1977). Several areas of conflicting or confusing responses in this study may reflect legitimate reasons for concern by Congress regarding institution of national health insurance. Belief that providers would benefit from mental health coverage in a national health insurance program was shared by 80% of respondents. Ninety-five percent of respondents identified the inclusion or exclusion of clinical psychologists in such a national health insurance as affecting the future of the profession. Curiously, over 50% of respondents agreed that primary care physicians should be reimbursed for mental health services, although such physicians have received no formal training in psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Too many psychologists? Worrying about Robiner and Crew (2000) and worrying with them.

This article responds to the very grim scenario presented by W. N. Robiner and D. P. Crew (2000; see record 2000-03894-001) regarding whether there are too many psychologists across the country. The authors of this article make a number of points: (a) Managed care data do not provide meaningful estimates of mental health needs, managed care may not be here to stay, and premature cutbacks in training programs; would have serious, long-term consequences; (b) the development of alternative roles beyond direct service delivery was not considered by W. N. Robiner and D. P. Crew; (c) though the internship and licensure data do not indicate rapid growth, there is a worrisome increase in new programs; (d) when compared with data from a local situation (exemplified by New Hampshire), W. N. Robiner and D. P. Crew's data and conclusions become questionable; and (e) the trend away from working full-time (perhaps the feminization of psychology) and the possibility of more insured lives with national health insurance change the conclusions. Nevertheless, each program's statistics, relevant to supply and demand, should be published. New roles should be developed for psychologists as should new internships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed Care: Implications for School Psychology. Comment.

Comments on the article by Sanchez and Turner (see record 2003-03405-005) examining the implications for practice and training in psychology in the era of managed care. The current author states that Sanchez and Turner should be commended. Their article amplifies and clarifies critical issues psychologists must consider while practicing within an era increasingly shaped by health insurance policies and practices. Nevertheless, the author feels that several intriguing facets of managed care were not highlighted. Discussion focuses on the impact that reimbursement and managed care is having on school (and clinical) psychologists. The author points out that it is unknown to what extent managed care may (and has) altered psychological services delivered by school psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rightsizing the workforce of psychologist in health care: Trends from licensing boards, training programs, and managed care.

The psychology workforce continues to expand despite changes within health care, such as managed care, that appear to reduce the demand for psychologists' services. Data from doctoral training and internship training are reviewed. Estimates of the psychology workforce are provided, including the authors' survey of psychology boards for 1995, which estimated there were 89,514 licensed psychologists in the United States. Growth in the field between 1988 and 1995 is estimated at 44%. Workforce estimates are applied to 3 HMO staffing models and population estimates, projecting a surplus of psychologists in many states. The authors provide suggestions for reducing the workforce, including improved monitoring of workforce size and reducing current training levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and nuclear war: A chapter in our legacy of social responsibility.

Notes that psychologists' participation in work on nuclear-war-related problems since 1945 has been sporadic and suggests that this sporadic research is related to fluctuating modulations in government policy. The history of these activities is viewed as a case that can be used to evaluate both the underlying forces of psychological research and the feasibility of a professional model of psychologists' social responsibility. The recent activities of psychologists suggest some alternatives for their involvement in global issues, specifically for rethinking what is psychological about such issues and for determining what problems might or should concern psychologists. It is suggested that psychologists must go beyond simply evaluating their science as a corpus of either intellectual innovations or ideologies. (88 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Clinicians, microcomputers, and confidentiality": Correction to Bongar.

Reports an error in "Clinicians, microcomputers, and confidentiality" by Bruce Bongar (Professional Psychology: Research and Practice, 1988[Jun], Vol 19[3], 286-289). In this article, the address given on p. 286 for correspondence to the author is incorrect. The paragraph should read as follows: Correspondence concerning this article should be addressed to Brace Bongar, Department of Psychology, College of the Holy Cross, Worcester, Massachusetts 01610. (The following abstract of the original article appeared in record 1988-33962-001.) Despite the microcomputer's ever-increasing popularity, one of its greatest strengths, the ability to store enormous quantities of text and data on small, concentrated types of magnetic media, could turn out to be an important structural weakness in the wall of client confidentiality that psychologists have so carefully constructed over the years. In this article I examine the possibilities for such breaches of confidentiality when psychologists use microcomputers in their practice or research. Examples illustrate the ease and rapidity with which the microcomputer's magnetic media can be duplicated, damaged, or destroyed. Recommendations are made for guidelines and techniques to ensure and maintain the confidentiality of clinical and research information when one is using a microcomputer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation: Psychology's greatest opportunity?

Rehabilitation (RHB) is one of the fastest growing areas in the health industry. Supported by several key pieces of legislation, psychologists have established themselves as integral health care providers in RHB. Although psychologists have benefited from legislated membership in RHB, most individual psychologists and the psychological associations have not recognized the importance of public policy for the practice of psychology. Escalating health care costs have resulted in major revisions in the manner in which health insurers reimburse treatment. Medicare, the major federal health insurance provider, increasingly has been viewed as a model for the provision of all health care. The historic exclusion of psychologists from Medicare has limited the scope of psychologists' practice and the growth of professional psychology. The recent inclusion of psychologists in Medicare improves but does not solve practice and policy issues confronting psychology. Knowledge of national health policy formulation and greater participation by psychologists in health policy are necessary to secure the scope of professional practice most psychologists expect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legal, professional, and financial constraints on psychologists' delivery of health care services in school settings.

Psychologists' participation in the delivery of health care (HC) services in schools will be determined in part by legal, professional, and financial constraints. Legal parameters include both current and proposed federal and state legislation related to education and HC as well as licensing and credentialing issues and legal and ethical complications arising from service integration across disciplines. Recognition of psychologists as HC providers in schools is also likely to be affected by credentials and standards for practice issued by various government agencies or professional associations and by the funding mechanisms established to support a reformed American HC system. The purpose of this article is to stimulate exploration of solutions for the obstacles and innovative responses to the opportunities presented for psychologists' participation in the delivery of HC services in schools. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ethical practice of psychology in a managed-care framework.

With the rise of managed healthcare, psychologists face new challenges to their professional ethics. This article examines the dilemmas posed by managed care in 3 areas: client care, the handling of patient data, and issues surrounding membership in a managed-healthcare organization. Case examples of ethical dilemmas and strategies for dealing with these challenges are presented. In an attempt to summarize the strategies used to cope with the ethical dilemmas presented in the case examples, global solutions for the ethical practice of psychology in a managed-care framework are also reviewed. These strategies include understanding managed-care policies, clear communication with the client, additional training, increased advocacy by clinicians, and ultimately, psychologists' involvement in the formation of these organizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older adults, reimbursement, and referrals: Implications for psychologists after Medicare reimbursement changes and before health care reform.

Psychologists' current provision of mental health services to older adults was investigated by a mail survey. One half of licensed psychologists in a metropolitan region in the Northeast were randomly sampled, with a return rate of 61% (n?=?37). 75% saw older adult clients (aged 65 and over), and 72% accepted Medicare payments. Older adults composed 8% of their practice. Solopracticing physicians were the chief referral link to and from the medical community. Barriers to providing mental health services included client's lack of social support network and low levels of reimbursement. The challenges of continuing psychologists' recent advances in serving the mental health needs of older adults in an era of health care reform and managed care are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed Care and the Independent Practice of Psychology.

How has managed care impacted the independent practice of psychology? The present article reports on data from 2 national surveys (from 1996 and 2001) that address this question. Both surveys indicated that managed care was a source of stress, with external constraints, paperwork, and managed care reimbursement being the most highly rated stresses. These stresses had not increased in the 5 years between surveys, and the most recent survey suggested that, overall, psychologists did not report high levels of burnout. However, in contrast to respondents with low managed care involvement, respondents with high managed care caseloads worked longer hours, had more client contact, received less supervision, reported more negative client behaviors, experienced more stress, were less satisfied with their incomes, and scored higher on emotional exhaustion. Implications for burnout are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology practice, ethics, and a changing health care environment.

Rapid changes in the health care environment have brought about ethical and professional challenges for rehabilitation and rehabilitation psychology. The response of rehabilitation psychologists to the threats and opportunities of these challenges will have an impact on the welfare of persons with disabilities and the future of the profession. Managed care organizations have focused their efforts on the management of acute illness. Ethical concerns are being raised about patient access to care, self-determination, confidentiality, provider accountability, and marketing in managed care systems. Rehabilitation psychologists' skills in program development and outcome evaluation place them in a key position to influence the changes in the health care environment. To be effectual, however, fundamental changes must be made in research psychology practice, education and training, research focus, and professional activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists, Resist Managed Care! Comment.

Comments on the article by Sanchez and Turner (see record 2003-03405-005) examining the implications for practice and training in psychology in the era of managed care. The current author, having had direct experience with the model of primary medical care and behavioral care interface that Sanchez and Turner seem so enthusiastic about, warns of several shortcomings. The author likens the psychologists role in managed care to a form of assembly-line practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of managed care on independent practice and professional ethics: A survey of independent practitioners.

Managed care significantly affects the service delivery patterns, business structures, ethics, and professional concerns of independent practitioners. This survey assessed psychologists' perceptions of the effects of managed care on practice and ethics. Most respondents reported significant increases in dependence on managed care services for income. Negative effects included loss of control over ethical decisions and potential harm to patients from erosion of confidentiality. A majority of respondents reported encountering ethical concerns not addressed by the American Psychological Association ethics code. Findings suggest directions for practice development, for public policy addressing confidentiality, and for clarification of ethical responsibilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The geography of APA membership.

APA membership is increasing rapidly. What can we say about this increase? Where are psychologists' centered? What geographical shifts have occurred over the years? Are we "promoting human welfare" throughout the United States or primarily in the more populated areas? We should possess these answers now and we certainly need them for intelligent future planning concerning the most efficient use of psychology. Unfortunately, we do not even know the number of psychologists residing in the various states. The present study was undertaken to answer these questions and also to supply basic data that would diminish the chore of doing additional much needed research in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development

BACKGROUND: Whereas organized trauma care systems have decreased trauma mortality in the United States, trauma system design has not been well addressed in developing nations. We sought to determine areas in greatest need of improvement in the trauma systems of developing nations. METHODS: We compared outcome of all seriously injured (Injury Severity Score > or = 9 or dead), nontransferred, adults managed over 1 year in three cities in nations at different economic levels: (1) Kumasi, Ghana: low income, gross national product (GNP) per capita of $310, no emergency medical service (EMS); (2) Monterrey, Mexico: middle income, GNP $3,900, basic EMS; and (3) Seattle, Washington: high income, GNP $25,000, advanced EMS. Each city had one main trauma hospital, from which hospital data were obtained. Annual budgets (in US$) per bed for these hospitals were as follows: Kumasi, $4,100; Monterrey, $68,000; and Seattle, $606,000. Data on prehospital deaths were obtained from vital statistics registries in Monterrey and Seattle, and by an epidemiologic survey in Kumasi. RESULTS: Mean age (34 years) and injury mechanisms (79% blunt) were similar in all locations. Mortality declined with increased economic level: Kumasi (63% of all seriously injured persons died), Monterrey (55%), and Seattle (35%). This decline was primarily due to decreases in prehospital deaths. In Kumasi, 51% of all seriously injured persons died in the field; in Monterrey, 40%; and in Seattle, 21%. Mean prehospital time declined progressively: Kumasi (102 +/- 126 minutes) > Monterrey (73 +/- 38 minutes) > Seattle (31 +/- 10 minutes). Percent of trauma patients dying in the emergency room was higher for Monterrey (11%) than for either Kumasi (3%) or Seattle (6%). CONCLUSIONS: The majority of deaths occur in the prehospital setting, indicating the importance of injury prevention in nations at all economic levels. Additional efforts for trauma care improvement in both low-income and middle-income developing nations should focus on prehospital and emergency room care. Improved emergency room care is especially important in middle-income nations which have already established a basic EMS.