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

Universidad de JaenMayo 31, 2002

BackgroundBackground

North Carolina Psychological Association National Academy of Neuropsychology Division of Clinical Neuropsychology of the

American Psychological Association Practice Directorate of the American

Psychological Association Policy & Planning Board of the APA American Medical Association’s CPT Medicare Program of the US Federal Government

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

APA MembershipYear Doctorate Masters Bachelors

1970 1505 457 2975 218319077 14602

1980 1921 1333 4096 5812 15440 26653

1990 1566 2245 3377 7353 15336 38616

2000 1405 2905 3552 10913 17402 56600

 

APA Membership by Division Approximately 150,000 members Approximately 50 different

divisions Top three divisions are:

Clinical Psychology Clinical Neuropsychology Independent Practice

What is Clinical Neuropsychology? 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 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 1569 returns 5791 mailed1569/5791 = 27.1%

Adjusted Return Rate Or returns, 1406

U.S., U.S., Doctoral, Licensed, Clinicians

Of mailed, 1590 excluded (duplicates, unintended, undelivered)

1406/4201 = 33.5%

Organizational Membership(All Doctoral Licensed Clinicians)

05

101520253035404550

NAN only(n=156)

D40 only(n=276)

Both(n=670)

Unknown(n=304)

Percent

Gender (All Doctoral Licensed Clinicians vs. Younger Samples)

62,3

37,7

0

10

20

30

40

50

60

70

Male (n=871) Female (n=528)

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%

Percent

Type of Doctoral Degree (All Doctoral Licensed Clinicians)

0

10

20

30

40

50

60

70

80

90

PhD (n=1225) PsyD (n=143) EdD (n=24)

Percent

Field of Doctoral Degree(All Doctoral Licensed Clinicians)

0

10

20

30

40

50

60

70

Clinical Couns. Neuro. School Ed. Psy. Comb.

Percent

Work Status(All Doctoral Licensed Clinicians)

0

10

20

30

40

50

60

70

80

Full Time Part Time Full + Part NotWorking

Percent

Work Setting(All Doctoral Licensed Clinicians)

0

5

10

15

20

25

30

35

40

PrivatePractice

Institution Comb. Other

Percent

Gender Within Work Setting(Doctoral Licensed Clinicians)

0

10

20

30

40

50

60

70

Private Institution Comb. Other

Male Female

Percent

Board Certification Status(Doctoral Licensed Clinicians)

0

10

20

30

40

50

60

70

80

Board Certified(n=271)

Not Board Certified(n=1053)

Percent

Weekly Professional Activities by Organization(All Doctoral Licensed Clinicians, exc. Part time)

01020304050607080

Clinical Pract.

Teach. Research($)

Res. (No $)

Non-ClinAdmin.

NAN D40 Both Unknown

Percent

Weekly Professional Activities by Organization(% for All Doctoral Licensed Clinicians, exc. Part time)

01020304050607080

Supervision Forensic

NAN D40 Both Unknown

Percent

Percentages of Reimbursement Sources(For All Doctoral Licensed Clinicians)

0

5

10

15

20

25

30

Managed Care

Medi- care

IndemnityInsur

Self Pay

CHAMPUS Public Aid

Indigent Forensic

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

78.228

99.296 107.856 108.794 103.336

0

20.000

40.000

60.000

80.000

100.000

120.000

NAN n=125

D40n=223

Bothn=581

Unkn.n=259

Overalln=1188

Mean Median

$

Correlates of Income(Rational selection; Full time and Full time +)

Years licensed .27** Work Setting -.25** % Forensic .24** Gender -.21** % Self Pay .19** Age .18**

Hrs billed/Eval .13**

% Public Aid -.12** % Medicare -.09* % Man. Care -.09* % Indemnity .07 % Indigent -.04

*=.05 **=.01 *=.05 **=.01 Negative correlations in red.Negative correlations in red.““Work Setting” above limited to Private and InstitutionWork Setting” above limited to Private and Institution

All All nns between 775 and 1185s between 775 and 1185

Income by Years of Licensure(Licensed Doctoral Working Full time or Full time+)

0 Yrs $44,763 (47K)

1-5 73,567 (63K)

6-10 93,172 (77K)

11-15 109,457 (88K)

16-20 118,776 (93K)

21-25 126,979 (102K)

26-30 152,359 (120K)

0 Yrs $44,763

1 66,810 (56K)

2 61,512 (61K)

3 69,061 (60K)

4 94,800

4 (minus outlier)

78,641 (70K)

5 73,596 (65K)

Stratification - Mean (Median) ‘Starting’ Salaries - Mean (Median)

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

127318

105000

7646370000

105149

87750

$0

$20.000

$40.000

$60.000

$80.000

$100.000

$120.000

$140.000

Private (n=424)

Institution(n=378)

Comb. (n=358)

Mean Median

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

120642

95000

75909 68500

$0

$20.000

$40.000

$60.000

$80.000

$100.000

$120.000

$140.000

Male (SD=117805)

Female (SD=44387)

Mean Median

Percent Change in Income in Last 5 Years(Doctoral Licensed Clinicians Working Full Time or Full Time+)

0

10

20

30

40

50

60

Less (n=238)

No Change(n=81)

More (n=464)

Hours Per Week Per Clinical Activity(Full-time and Full-time plus Doctoral Licensed Clinicians)

3,32,1

13,73,7

2,12,5

4,90,6

2,22,1

0 5 10 15

DX Interv Nbeh Ex Npsy Test Psy TestF/ Up Ass. TX (BD) TX (No BD) CogRehTx plan Superv

Evaluation Time by Evaluation Goal(Hrs. for All Doctoral Licensed Clinicians; 5th & 95th%ile in parens.)

6,3

4,4

4,2

4,8

9,3

0 2 4 6 8 10

Determ DX (n=1022) (1-16)

TX Plan (n=914) (.5-12)

Pre/ Post (n=566) (1-10)

Baseline (n=784) (1-10)

Forensic (n=790) (1-20)

(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)

319

260

050

100150200250300350

Private Institution

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

Minutes

Use of Testing Assistants(All Doctoral Licensed Clinicians)

51,2 48,8

0

10

20

30

40

50

60

Yes (n=692)

No (n=660)

Percent

Use Of Testing Assistants By Work Setting

72

48

46

51

39

0 20 40 60 80

Private Practice

Institution

Combination

Other

Total

Percent Using Assistants(n=1349)

CPT Code for Activities Frequency Percent

Intake Interview 90801 96117 96115 Other (16 codes)

2311064021

16.57.62.91.5

Clinical interview/history 90801 96117 96115 Other (20 codes)

 2501805934

 17.912.94.22.4

Test administration 96117 96100 96115 Other (12 codes)

 498379

21

 35.72.70.61.5

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

CPT: Applicable Codes Total Possible Codes = 7,500 Possible Codes for Psychology =

Approximately 40 to 60 Sections = Five Separate Sections

Psychiatry Biofeedback Central Nervous Assessment Physical Medicine & Rehabilitation Health & Behavior Assessment &

Management

CPT: BackgroundCPT: BackgroundAmerican Medical Association

–Developed by Surgeons (& Physicians) in 1966 for Billing Purposes

–7,500 Discrete Codes

HCFA/CMS

–AMA Under License with CMS

–CMS Now Provides Active Input into CPT

Congress

–Trent Lott (2001)

Current Problems Current Problems Definition of Physician

Supervision

Face-to-Face

Time

RVUs

Qualification of Technicians

Payment

Focus for Fraud & Abuse

Potential SolutionPotential SolutionBetter Understanding & Application of CPT

More Involvement in Billing

Comprehensive Understanding of Pay Sources

More Representation

National & Local Interest Groups

Predictions for FuturePredictions for FutureIncome

–Steadier (if economy does not further erode)

–Probable incremental declines, up to 10-20%

–“Final” stabilization by 2005

Recognition

–Physician Level

–Mental vs. Physical Health

Paradigms

–Industrial vs. Boutique

–Health vs. Non-Health

Future ProblemsFuture ProblemsWhat Will be Future of Training Programs?

Health Care vs. ?

–Who will take care of “mental health” patients?

–Will “mental health” & psychotherapy be MS level?

–What about prescription privileges?

Boutique Health Care as Income Protection?

Initial Results of APA Survey Procedure

Five Year Review of Status of APA & Psychology

Random Survey of APA Membership, Staff, & Governance

Results Public Image of Psychology Protecting & Expanding Sources of Income Membership Concerns

What About Our Students Sex Differences Competition from Classically Well-

Defined Professions (e.g., medicine)

Limited Scientific Base Attitudinal-Personality Traits

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

to Health, to Other Areas Vibrant and Unpredictable yet

Exciting

Defining the Defining the Future…Future…

New Paradigm = Change

Be Prepared

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