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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