How to create independent practice status for Ph.D. graduates who have not yet completed their postdoctoral training will be among the knotty problems to be tackled by a new commission established in February by the American Psychological Association Council of Representatives.
A 30-member cross-constituency Commission on Education and Training Leading to Licensure in Psychology will have one-year and a $98,200 budget to solve problems triggered by a changing healthcare marketplace that ignores modern graduate school curricula that turn out better prepared clinicians than previously.
The Council approved creation of the Commission following lengthy debate which drew both approval and skepticism that recommendations to solve such an intricate problem can be resolved in such a short time.
Norine G. Johnson, Ph.D. of Boston, APA president-elect, will head the commission that will examine proposals to help new graduates to obtain funded postdoctoral positions or entry level jobs following graduation.
State licensing laws require that postdoctorates complete a year of supervised internship before being allowed to sit for the licensing test. This requirement also generally means that services provided by postdoctorates are not reimbursed by insurance companies or managed care, since only licensed psychologists are eligible for third-party reimbursement.
The current system is particularly difficult for many students who run up graduate school debts as high as $100,00 and many of whom are forced to declare bankruptcy before they even begin their careers in psychology, according to the APA’s Graduate Student Task Force on New Professionals.
Repayment of many student loans are due upon graduation and any grace period allowed is normally used up by the end of the postdoctoral year, the task force reported.
Johnson said support for changing the current system “is coming from students, new graduates, graduate programs, training programs, state psychological associations and the practice community.”
She said the commission will develop recommendations that both modify the sequence and content of psychological education, training and licensure, and ensure the quality of psychology education. The goal is to and enhance the marketplace viability of psychology doctoral graduates.
“We must address the barriers to our new graduates obtaining reimbursement and employment opportunities that are commensurate with their doctoral education and their extensive training,” Johnson told the Council.
APA Recording Secretary Ronald F. Levant, Ed.D., a member of the task force, said the postdoctoral year of supervised clinical practice was a holdover from the 1960s and 1970s when students had little, if any, clinical training or experience before graduation.
Today, Levant said, new psychologists often graduate with at least 3,000 to 4,000 hours of clinical training before they are even conferred a doctoral degree.
“Is the postdoctoral year still a necessary inconvenience, or has it simply become a stumbling block that turned into a significant detriment to budding psychologists?” Levant said.
Johnson said early study of the issue led to two suggestions that many thought would solve the postdoctoral year problem. One solution proposed would have asked the states to create provisional licenses that would permit third-party reimbursement. The second was to open up state licensing laws to allow qualified graduates to begin their careers in paid psychology upon graduation.
But a survey conducted recently by PriceWaterhouseCoopers revealed that insurance companies and managed care have no intention to recognize provisional licenses for reimbursement purposes. Medicaid and Medicare also will not reimburse psychologists who have not been licensed by their respective state boards.
State psychological associations have long expressed concern about opening up licensing laws to remedy the postdoctoral problem. They feared that opening up the licensing laws could lead to extension of psychology’s scope of practice to other groups, particularly masters in psychology.
There was also concern that the medical profession would attempt to reduce or limit psychology’s scope of practice if state laws were opened.
Johnson said the problem is much more complex than originally thought and will require the participation of all groups involved in education, training and licensure.
The Commission will contain representatives from the APA’s Board of Directors, the Board of Educational Affairs, the Board of Professional Affairs, the Board of Scientific Affairs, the Board for the Advancement of Psychology in the Public Interest, and the Committee for the Advancement of Professional Practice.
Other groups that will have representation on the Commission include the association Psychology Postdoctoral and Internship Centers, the Council of Chairs of Training Councils, the Council of Graduate Department Chairs of Psychology and the Council of University Directors of Clinical Psychology Programs.
The Association of State and Provincial Psychology Boards (ASPPB) and about 10 other organizations will also have seats on the Commission.
Of the nearly $100,000 appropriation from the Council, $58,000 will be spent on two two-day meetings of up to 30 members and $40,200 for the salary and benefit expenses of one full-time staff person to coordinate the work of the Commission.