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

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

APA Membership YearDoctorateMastersBachelors

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:

Survey Return Rates Actual Return Rate 1569 returns 5791 mailed 1569/5791 = 27.1% Adjusted Return Rate U.S., Or returns, 1406 U.S., Doctoral, Licensed, Clinicians Of mailed, 1590 excluded (duplicates, unintended, undelivered) 1406/4201 = 33.5%

Organizational Membership (All Doctoral Licensed Clinicians) Percent

Gender (All Doctoral Licensed Clinicians vs. Younger Samples) 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) Percent

Field of Doctoral Degree (All Doctoral Licensed Clinicians) Percent

Work Status (All Doctoral Licensed Clinicians) Percent

Work Setting (All Doctoral Licensed Clinicians) Percent

Gender Within Work Setting (Doctoral Licensed Clinicians) Percent

Board Certification Status (Doctoral Licensed Clinicians) Percent

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

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

Percentages of Reimbursement Sources (For All Doctoral Licensed Clinicians)

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

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 Negative correlations in red. “Work Setting” above limited to Private and Institution All ns between 775 and 1185

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

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

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

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) 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) Percent

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

CPT Code for ActivitiesFrequencyPercent Intake Interview Other (16 codes) Clinical interview/history Other (20 codes) Test administration Other (12 codes) 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: Background American 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 Definition of Physician Supervision Face-to-Face Time RVUs Qualification of Technicians Payment Focus for Fraud & Abuse

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

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

Future Problems What 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 Future… New Paradigm = Change Be Prepared Contribute Enjoy