Condensed from a summary prepared by Gary DeNelsky, Ph.D., of the 57 issues of The National Psychologist printed from January 1991 through June 2001published in the 10th Anniversary Edition, July/August 2001. DeNelsky was a longtime friend and confidant of the newspaper’s founder, Henry Saeman. DeNelsky founded the Cleveland Clinic’s Smoking Cessation Program and was its director for 20 years before retiring in 2001. He remains active in tobacco control and stop smoking efforts in the Cleveland area.
“Managed care” was largely a theoretical term when the first issue of The National Psychologist was published carrying a debate on the topic between Nicholas Cummings, Ph.D., and Rogers Wright, Ph.D.
Cummings wrote that health care was leaving its status as a “cottage industry” and becoming industrialized. Wright countered that “Managed care is not really a solution but a delaying action.”
The following spring, the paper carried an article in which Cummings asserted that “APA has essentially been saying managed care will be dead in two years,” a prediction he found faulty. But he noted that there might be signs of “a willingness to change” because there had been several meetings between APA’s Practice Directorate and a number of Fortune 500 companies.
In July of 1992, however, The National Psychologist reported that “No accord (was) seen in an APA summit meeting with top officials of several managed care companies.” Bryant Welch, J.D., Ph.d., then head of the Practice Directorate, proposed an alternative to managed care, “integrated care.”
Psychologists remained divided on whether managed care would inevitably engulf the mental health field with some suggesting adapting to it and others shunning it entirely. In the March/April 1994 edition it was reported that a group of psychologists interested in forming a new division in APA to deal with managed care issues met all the required formalities but the APA Council of Representatives rejected the proposal.
In 1995, Cummings wrote that he expected by the year 2000 the “physician equity model” would be dominant and urged psychologists to be shareholders in the new model. Some who were previously opposed to managed care began urging cooperation. Jerry Morris, Ph.D., noted, “Psychologists will not survive by stubbornly rejecting 20 years of changes.”
Throughout the next decade, managed care continued to draw fire, including lawsuits contending that the profit motive dominated over concern for patients. State legislatures wrote bills trying to manage managed care and Congress weighed in at least in principle. In a 1998 article, then-U.S. Rep. Ted Strickland, D-Ohio, predicted that managed care reform would be high on Congress’s agenda.
In 2001 in California, the Department of Managed Care debuted and a Princeton economist predicted that the nation would not solve its health care delivery system problems “in the foreseeable future.”
The push by some psychologists for prescription authority was the second most reported on issue of the decade. In 1992 the Department of Defense (DOD) enrolled its second class of military psychologists for training to prescribe psychoactive medications.
A detailed debate on the pros and cons of prescribing authority was presented in the newspaper. Pat DeLeon, Ph.D., J.D., who would become known as the father of the RxP movement for psychologists, presented the argument for RxP, and Gary DeNelsky, Ph.D., gave the opposing view.
Psychiatry attempted to derail the DOD program in 1994 but Congress rebuffed the effort. The November/December 1994 edition carried a two-page advertisement announcing the founding of the Prescribing Psychologists’ Register, and in the March/April edition of 1995 the front page headline read: “Psychiatrists declare war on prescription rights.”
The APA Council of Representatives voted to endorse psychologists seeking RxP in 1995. The following year the DOD announced the RxP training would continue until 1997 but no new classes would be enrolled after that. Psychiatry claimed a victory but the DOD decision actually was based more on budget concerns.
Courses on prescription training for psychologists were expanded, especially at professional schools, and enrollments grew, although as many as half those applying indicated they would not personally seek prescription authority, apparently desiring the training primarily to advise medical doctors and to understand patients who were being prescribed such medications by physicians.
By the end of the newspaper’s first 10 years of existence, the American Society for the Advancement of Pharmacotherapy, APA Division 55, was in place, but the only jurisdiction that had approved RxP for psychologists was the Territory of Guam.
In 1992, the APA allocated $500,000 to help practicing psychologists establish a better position in the health care marketplace, and sensing that health care reform was coming, the Practice Directorate launched an aggressive “$100 for 100 days” fundraising campaign from psychologists designed for use in gaining status for psychology in the health plan designed by President and Hillary Clinton.
A few months later, Bryant Welch, J.D., Ph.D., left his post as executive director of the Practice Directorate and became APA’s “health care reform consultant.” Russ Newman, Ph.D., J.D., became acting interim director executive director of the Practice Directorate and was later promoted to executive director.
Tensions between Welch and Raymond Fowler, Ph.D., APA’s CEO, reportedly were factors leading to Welch’s resignation and to a “brouhaha” surrounding renewal of Fowler’s contract. Ultimately, Fowler was re-confirmed by an overwhelming 87 percent vote of the APA Council of Representatives.
Criticism of APA’s stand against managed care continued with Nicolas Cummings, Ph.D., remarking in 1994 that APA’s direction was “off course and low on the reality scale” and “increasingly irrelevant” by contending that managed care under any circumstances is “antithetical to the treatment process.”
Cummings founded Biodyne, the first large managed care organization providing mental health services, and became a millionaire.
In 1999 The National Psychologist carried a feature story crediting then-Finance Officer Jack McKay with bringing APA back from the brink of ruin after its disastrous purchase of Psychology Today.
In 2000, APA reorganized in an effort to insure compliance with IRS regulations. APA retained its 501(c)(3) status but established the Practice Directorate as a 501(c)(6) organization with greater flexibility to lobby and provide advocacy services for practitioners.
There was one note of humor in chronicling APA’s operations. At one point, the APA inadvertently gave out the wrong phone number for CE credits. Unsuspecting CE seekers who called the number were connected instead to a sex hotline.
Many issues relating to licensing in the first decade of the newspaper’s existence continued to arise periodically in the second decade, including efforts to protect the doctoral standard for licensing as a psychologist and the concern of many psychologists that licensing boards regularly deny due process to psychologists accused of ethical infractions.
The North American Association of Masters in Psychology (NAMP) made a concerted but largely ineffective effort to gain the right for those with masters training in psychology to practice independently while the APA Council voted overwhelmingly that the doctoral level should continue as the entry level for the practice of psychology.
The doctoral requirement remained the predominant model, but there were exceptions, including West Virginia and Vermont, which licensed masters-level practitioners as psychologists, and Kentucky which passed a law enabling those with master’s degrees to practice independently using the title “licensed psychological practitioner.”
The issue of whether licensing boards were unfairly punitive in hearing complaints against psychologists continued to relate back to the ultimate role of the boards, which is generally viewed as weighted toward protecting consumers rather than grooming professionalism among practitioners. One offshoot has been an expansion in the availability of insurance to cover expenses incurred in board proceedings under malpractice insurance contracts.
CAPP v. Rank, was the lead story in the inaugural issue of The National Psychologist and was viewed as a landmark decision in which the California Supreme Court ruled in favor of psychologists wishing to provide inpatient services.
It was believed that ruling would end hospital discrimination against psychologists, and hospital privileges for psychologists were subsequently established by law in Louisiana. In 1993, a new psychiatric hospital in Georgia granted full privileges to psychologists.
But the advent of managed care reduced inpatient utilization and many MCOs eliminated reimbursement for inpatient psychotherapy and assessment. The current health care reform is still being shaped, making it difficult to assess whether it will change matters in that area, but the emphasis on cost containment seems to make it unlikely.
In short, psychological practice expanded in many areas but psychiatric hospitals have not shown a major gain for psychologists.