“How can we look after the interests of patients while our own livelihoods are threatened and in decline?s”
Although at the moment healthcare reform appears to be stalled, one thing is for sure: we can expect that any changes will have a negative impact on mental health and mental health practitioners. What that change bodes for psychology practitioners may not be very encouraging. Few people like to hear news that is negative, and psychologists are not exempt from this very human attitude. Yet, we also know that looking away from negative events has placed our profession in a difficult situation. For many years now solo practice has been tougher to maintain. Reimbursements go lower while referrals are more diffcult to sustain and grow a practice. There seems to be a limit to what marketing can do, even though many practitioners appear limited in their marketing options and abilities.
Clearly, managed care continues to be one reason for the decline in practice opportunities. The medical takeover of mental health has bene ted only a relative few, while patients and practitioners have been the big losers. The sheer volume of mental health practitioners is another factor contributing to declining practice opportunities.
Unlike nursing, for example, where a shortage of nurses has given way to expanded practice and higher salaries and bene ts, psychology practitioners are in a surplus. Professional schools of psychology continue to produce new psychologists and continue to train our competition by turning out master level providers. It is a given that these issues would have a signi cant impact on doctoral level practice, but in my opinion, we still might be able to utilize these negative forces to our bene t. The fact is, as a profession, we have not developed nor convinced practitioners to accept or implement any realistic strategies to do so.
The Word Guild Is Not a Dirty Word
One explanation for shying away from strategic planning is that APA and state associations have steered practitioners from even thinking about psychology practice as a guild – yes, a guild. Guilds are associated with most professions’ existence and growth. Nurses, for example, have become one of the largest and powerful guild in healthcare. The American Medical Association is a guild. So is the American Psychiatric Association. Even the counselor’s organization is a guild. These guilds masquerade as professional associations, but their main focus is preserving the economic interests of their members and their profession.
The word “guild” in psychology has been associated with notions of “unethical,” “self serving,” and “contrary to patient interests.” The fact that so many practitioners have bought into these misplaced notions is the basis of why we are in decline while our competition has grown and prospered. Where are the objective data in support of the idea that practitioners compromise the standards of care because we advocate and pursue a decent living concomitant with our education, training, and experience? We should not separate the provider from the providee. How can we look after the interests of patients while our own livelihoods are threatened and in decline?
This is no different than advocating for higher wages for teachers and relating this to better education, or, to nurses’ salaries, for that matter. As long as we keep our association and identi cation with the psychology of the past, doctoral level psychology practitioners will soon become the equivalent to the Dodo bird. Moreover, in the present political climate, it is doubtful mental health will even remain a covered bene t in a patient’s insurance portfolio. This is no, “The sky is falling!” Chicken Little scare tactic. Every discussion about healthcare reform in the Congress eliminates mental health as a covered benefit.
Are We Healthcare Providers or Not?
While insurers will likely experience the largest gains form any change in healthcare reform, psychology practice will not be as fortunate. If we do not acknowledge the paradigm shift and organize as healthcare providers, we will become extinct via slow genocide. We can’t have it both ways. Individual practitioners cannot fight insurance companies for healthcare services while continuing to identify and support professional associations that were designed for professors and academic institutions. Once we became licensed and entered practice, we became a di erent specie. That blame I put on APA and state associations, and speaks to the issue of not being honest with practitioners and academics, alike.
APA cannot serve practice interests while also serving academic interests, but they do this because they need dues money. They corrupt and distort the true meaning of guild issues so they won’t have to act in our interests, thereby mollifying our academic colleagues and keeping them in the fold. The real hypocrisy is that our academic colleagues belong to unions, while simultaneously slamming practitioners for seeking better working conditions. I blame APA for not admitting this glaring conflict of interest and illusory perpetuation of the notion of, “working to serve practitioners.” APA appears to have no problem
with their guild issues as long as they are able to continue to collect their exorbitant dues. The model of the “scientist-practitioner” does not now serve the needs of today’s practitioner. We must be able to be knowledgeable in science-related issues, but we are practitioners. Physicians do not have this problem. They would never consider themselves to be “scientist-practitioners.” Nevertheless, we as individual practitioners also must bear the responsibility and blame for our current situation.
Many of us have kept our heads in the sand and continue to deny the obvious. Our association and collaboration must be with each other and with other guilds. This is how other healthcare professions thrive, grow, and continue to advocate for their profession and their consumers. My experience is that physicians prefer to work with psychologists and respect what we bring to the table. Physicians and their guild, however, have no time nor inclination to advocate for our profession. It is time for psychologists to recognize we need to organize a national guild.
Psychology Needs a National Guild: Some History
In 2006 through 2009, NAPPP had many discussions and several meetings in Washington, DC with
other psychology associations and with the Service Employees International Union (SEIU). Our goal then was to form a national guild that would represent practitioners and to have the power and in uence of a major healthcare union. We were not able to achieve this goal because the leaders of these other association saw no reason to organize. Three years of hard and diffcult work was lost down the drain because these leaders had no real vision for the future or concern for anything other than maintaining an illusory vision that they had power on their own.
NAPPP is the only viable, national organization dedicated to practitioners and practice. Our mission has always been to elevate our profession and practice. We have always advocated for better healthcare and better patient care. We believe that it is time to once again resurrect the idea that practitioners need a national guild to confront the forces that clearly pose
a threat to our profession, practice, and patients. In essence, NAPPP is advocating what should have been done by APA.
What Can Practitioners Do?
Practitioners must reassess where their interests will best be served. Will it be in our interests to remain alone in practice without power or in uence? It doesn’t have to be an “either or” situation. We can continue to have memberships in any organization
of our choosing, but when it comes to issues that are common to practice, for example, dealing with insurers on reimbursement, with state BOPs on practice issues, with the various government and quasi-public employers with employment issues, we need a national strategy and guild. How can we otherwise survive in the current and likely future environment?
Over the next few weeks, NAPPP will be conducting a survey and asking for feedback on some of these issues. That feedback will allow us to formulate a strategy for going forward.
The results of the survey will be published in a future edition of The Clinical Practitioner.