Neuropsychologists have split from the New York State Psychological Association (NYSPA) over disagreement on the use of technicians in their practices.
The State Department of Education, which regulates psychology and 47 other professions, ruled that no psychologists may use technicians and when the NYSPA executive board endorsed the ban in December, neuropsychologists walked out.
Accepting the policy would have eliminated the way the vast number of neuropsychologists practice. This was considered totally unacceptable to neuropsychologists, who concluded that NYSPA was out of step with national practice standards and neuropsychologists could not have their interests represented by a group composed of so many disparate factions that do not under- stand the intricacies of neuropsychological practice.
With the mass resignations from NYSPA, the association’s Neuropsychology Division ceased to exist. The division formerly had about 200 members, including about 30 student members.
“This has been such a contentious and bloody issue that it has divided our organization,” said Peter Kanaris, Ph.D., member at large of the NYSPA executive committee. “The issue of technicians has been discussed and argued for about eight years.”
Following the passage of a state scope of practice bill in 2003, an interpretation by the state education department led to the elimination of the ability of psychologists to use technicians.
Soon after passage of the bill, an official of the New York State Department of Education issued a statement that firmly denied the use of technicians, said Joanne Festa, Ph.D., president of the New York State Association of Neuropsychology (NYSAN), which neuropsychologists formed last year independent of NYSPA.
Festa said Kathleen M. Doyle, executive secretary for the education department’s Board for Psychology, also wrote an interpretation that disallowed the use of technicians. “So this is what we have been fighting all these years. When the scope of practice bill was put through the people who were working on it in NYSPA never intended for technicians to be banned,” Festa said.
But when the interpretation of the bill was issued, some divisions of NYSPA approved of it as a way to protect them- selves. “They feared for their jobs,” Festa said.
Kanaris admitted that the letter interpreting the use of technicians was unintended. “I think it affected many psychologists, neuropsychologists the hardest.” Neuropsychologists lobbied against the interpretation and tried to get a change in the law so they could once again use technicians, which they had been doing freely for decades, Kanaris said.
But the effort to try to change the law concerned school psychologists because they saw this as a potential opening for technicians to step into school districts normally populated by psychologists. “I think basical-ly what they did was to express a concern that changing the language of the law would let technicians do some of the work of psychologists in schools.”
The second problem raised was that somehow the meaning of the scope of prac-tice law would be lost, Kanaris said, that a change in the law would say anybody could do the work of a psychologist. “It was prob-ably more of something that created fear for psychologists in general, particularly clinical psychologists,” who joined with school psychologists to fight any changes, he said.
When clinical psychologists joined school psychologists in support of the ban, the NYSPA automatically went along. Most states allow the use of technicians. “New York and New Jersey are the outlaws on this position,” Kanaris admitted.
States that support the use of technicians developed and promulgated regulations in accordance with the literature of psychology, Festa said. She added that there are many professional articles and statements about the appropriate use of trained technicians.
“We have regulations and guidelines from the different governing bodies. All the major national organizations of neuropsychology support the use of technicians and have published papers on the appropriate use of them.” Festa said.
“It is very idiosyncratic for our state to make a determination about this particular practice that goes against Medicare and Medicaid that supports the use of technicians and pays for their services,” Festa said.
“With the support of federal agencies that governs the billing and coding of all different kinds of medical procedures, including psychotherapy and mental health, all these codes are based on reviewing what is appropriate practice. CMS (the Centers for Medicare and Medicaid Services) supports the use of technicians.”
Many New York psychologists believe the use of technicians will harm their prac- tices and benefit only neuropsychologists. “This has been the perception and that is the basis of the decisions by NYSPA,” Kanaris said.
Festa said, “There is no evidence from years prior to 2003 that it ruined school psychologists’ practice. People are fearful now and everyone is afraid for their jobs,” Festa said. She said there is no evidence that clinical practices in other states were ever harmed by the use of technicians.
“They are reacting to their own fears. When people get scared they do things they would not normally do. They do irrational things. We need to get ourselves back to where we started before 2003,” Festa said.