2017 APA presidential candidates answer questions about practice

What do you believe are the most important opportunities and challenges facing professional practice in the next three to five years, and how would you address them?

I see three. First, how do we continue to make our face-to-face therapeutic style relevant to a tech-savvy population used to brief, real time interactions on social media? Many of us are trained for longer-term work, or even with short-term work; in either case we still like to physically see our clients. As practitioners we may want to be proactive in relation to social media instead of being reactive to the changes.

Second, the need for interdisciplinary training and work will continue to grow. In order to increase our relevance in that arena, it is essential that psychologists consider board certification when available and when it facilitates our collaborations. We will be best served to keep reaching out across the professional lines to enhance all of our work.

Third, although it is an old point, it continues to be important — actually using our research in professional practice. I think we’ve gotten better with this over the years, but there is always more room for applied research. One way to do this is by highlighting the opportunities for funding more applied work. 

What would you identify as your priorities for ensuring that psychologists will have a pivotal role, front and center, in leading and implementing health care reform?

I love the energy demonstrated by today's health psychologists. The pioneers in this area were successful at the grassroots level at getting us a seat at the health care table. I would love to see more reform work championed by board certified psychologists, not just directly in health care but also in consultation and organizational realms, among others. Psychology’s influence must come from a variety of fronts, as traditional practitioners can't do it alone. Health care reform affects all of us. I know we already are effective with our current lobbying efforts, but we will be even more effective when we have persuasive voices on various decision-making panels, be those local hospitals and community health centers to other policy making panels within government and the private sector. The perennial problem, of course, is that many psychologists are too busy in the trenches to offer to serve long-term, but even short-term assistance is valuable. If they don't convince people to serve we run the very big risk of being cut out of the picture.

What do you believe are the most important opportunities and challenges facing professional practice in the next three to five years, and how would you address them?

Health care operates as a business. In the past, health care financial decisions have been made primarily by physicians and insurance executives. Over the next three to five years as “citizen psychologists,” the opportunity-challenge involves forming collaborations resulting in our being present in the room when decisions are made about health care finances. We must initiate and sustain those relationships with decision makers if we hope to implement quality integrated health care for all Americans based on science.

The health care decision makers reside in our respective communities and serve on state and local boards and committees. Psychologists appointed or elected to those boards can form cordial working relationships with these individuals. Committee and board members who become colleagues may in turn provide psychologists with access to policy making and policy implementation boards and committees. These changes will not happen instantly, but require relationships that can be nurtured over time. 

Through collaborations and leadership, psychologists can identify the critical boards and committees as they work their way through and up the committee-board structure in their respective communities. The goal is to be a leader-participant who is seen as a collaborator with expertise, informed by science.

What would you identify as your priorities for ensuring that psychologists will have a pivotal role, front and center, in leading and implementing health care reform?

My first priority will be supporting psychologists involved in leading and implementing health care reform. APA must recognize these individuals including members of state, provincial and territorial psychological associations (SPTAs) as well as divisions. We need recognition at the state, regional and national levels. I want the focus on health care to become a more central and better integrated part of APA culture. That systematic recognition will keep it front and center.

Second, in addition to the Capitol Hill visits associated with the State Leadership Conference and the Education Leadership Conference, APA must integrate education and training about regulatory change into the graduate school curriculum. The socialization of our young colleagues into the discipline should include forming relationships with a range of power brokers whose decisions effect the delivery of health care in the United States. An emphasis on mastering both negotiation skills and the preparation for visits with power brokers would produce psychologists who feel confident and competent in becoming change agents.

Third, forming collaborative relationships with other disciplines that have a vested interest in health care will be critical. The American Public Health Association would be an example of a primary target, as they too are a data-driven discipline. We need to cultivate allies.

What do you believe are the most important opportunities and challenges facing professional practice in the next three to five years, and how would you address them?

Let’s monitor and confront insurance company practices and publicize an annual report of our findings. Practicing outside the influence of insurance companies feels easier. However, psychologists shouldn’t be driven away from participating on insurance panels simply because corporations delight and revel in making it onerous for psychologists to participate on insurance panels. Over the next three to five years we’ll frequently talk about health care reform; talking about it must include talking about insurance company practices. We must ensure that insurers treat the public fairly under mental health parity. We must ensure that they are maintaining adequate networks of psychologists. Their beneficiaries shouldn’t have to deal with long wait times or inadequate access to psychologists specializing in their presenting problems. It’s unacceptable that some insurance panels are closed or require three to five years post-licensure before a psychologist can apply to it while their beneficiaries must call around endlessly and report trouble finding a psychologist who was available and who could take their insurance.

Another challenge facing a large percentage of psychologists is that too many employment opportunities require APA-accredited internships. We’ve all seen the ads. I want our professional associations to stop publishing classified ads that require APA-accredited internships.

What would you identify as your priorities for ensuring that psychologists will have a pivotal role, front and center, in leading and implementing health care reform?

APA leaders delight and revel in stating the obvious that psychologists “need a seat at the table.” However, to the survivors of the internship crisis and psychologists without APA-accredited internships, this rings hollow. It rings hollow when only some psychologists get to have a seat at the table and not all psychologists. It rings hollow when psychologists without APA-accredited internships are left without a chair when the music stops. It rings hollow when APAPO has spent millions pursuing prescription privileges yet remains silent while we can’t even apply to our largest employers. Psychologists are one of the top five occupations with the largest staffing shortages at the VA, yet our state licensure is treated as meaningless there. We deserve an APAPO that will speak for us. We shouldn’t be left behind and APAPO’s approach shouldn’t be to sit back and watch us die.

My priorities also include my fellow small business psychologists. We shouldn’t be left behind while large corporations take over. Let’s not celebrate any pay-for-performance reforms which don’t let our small businesses succeed; we know from history that change hasn’t always been for the better. APAPO’s approach shouldn’t be to sit back and watch our small businesses die.

What do you believe are the most important opportunities and challenges facing professional practice in the next three to five years, and how would you address them?

There are various issues facing psychology, both as a science and as a clinical health care profession. These include, but are not limited to:

1. The assessment, care and treatment of returning veterans and “wounded warriors,” together with the recognition of PTSD and other conditions associated with military service and police and firefighter burnout.
2. The integration and broadening of psychological/behavioral modalities to more than traditional psychiatric venues. This includes increasing patient compliance with diabetes regimens, etc., when there is the potential for savings over the long run in delaying or even preventing medical complications. 
3. Assuring that psychologists have a place as “doctors” in emerging health care models.
4. The profession as well as underserved patients will benefit from prescribing psychologists in every state, appropriately trained.
5. Psychologists serving as full medical staff members in hospitals. 
6. Psychologists’ involvement and leadership in “telehealth.”
7. Psychologists’ increased involvement with VA hospitals, including having full medical staff privileges.
8. Psychology being recognized as a “STEM” discipline. Psychology must make important direct and indirect contributions to other sciences, technology, engineering and mathematics disciplines. Psychological research must also play a central role in addressing some of the world’s biggest and most pressing issues. 

What would you identify as your priorities for ensuring that psychologists will have a pivotal role, front and center, in leading and implementing health care reform?

Psychologists can have a pivotal role in leading and implementing health care reform by:

1. Lobbying for research funding to help find solutions to current problems such as heart disease, cancer, lung ailments, cirrhosis of the liver, PTSD and suicide, all of which have strong behavioral and psychological components.
2. Protecting the independent practice of psychology. Psychologists must take a strong stand in support of independent practice by enhancing reimbursement and appropriate coding for assessment, consultation and psychotherapy.
3. Expanding their roles as consultants and coaches. Health care offers many new opportunities in these areas (leadership, communication, patient satisfaction, etc.). Psychologists need to focus on non-health care psychological practitioners such as police psychologists, forensic psychologists, consulting psychologists and industrial-organizational psychologists to enlarge their market opportunities.
4. Educating the public about psychological science and practice. In order to improve the health and well-being of all people, it is incumbent upon psychologists to serve as leaders in communication, public education and advocacy.
5. Advancing social justice. psychological science, education, practice and use of legal amicus briefs can help eliminate inequities in our society such as racism, ageism, sexism, homophobia, anti-Semitism and bias against people with disabilities. Veterans’ issues will also be attended to actively.

What do you believe are the most important opportunities and challenges facing professional practice in the next three to five years, and how would you address them?

For the last year I have been involved in surveying approximately 10,000 APA members to gauge ranking of the professional challenges. Last year’s survey revealed that the top four challenges (in order of importance) to respondents:

1. Protect reimbursement.
2. Protect the doctoral degree as a standard for psychology licensure.
3. Address health care reform.
4. Protect and enhance psychology’s scope of practice.

This year’s survey indicated that the most important challenge is inclusion of psychologist in Medicare’s definition of physician. The second challenge is how to get reimbursed for the provision of integrated care.

As to opportunities, they are plentiful. In another survey from last year the following opportunities were outlined based on prior presidential initiatives. They included:

1. Translating psychological science for the public.
2. Educating and engaging the next generation of psychologists.
3. Provide psychological services to the military.
4. Advancing psychological knowledge.

This year integrating psychology into the larger health care system was by far the most important opportunity, which would most likely be spearheaded by current APA efforts to obtain reimbursement for such activities. This integration of psychological services would 1) increase efficiency, 2) decrease costs and, 3) expand the scope of psychological practice.

What would you identify as your priorities for ensuring that psychologists will have a pivotal role, front and center, in leading and implementing health care reform?

I see the priorities as being at three levels: federal, state and local. Accordingly, my priorities are as follows:

1. Include psychologist in the Medicare definition of physician.
2. Protect and expand the scope of practice of psychology including but not limited to obtaining a CPT code for integrative care. We should consider the examination of current Health and Behavior as well as testing codes (especially reimbursement of integration of data and feedback to the client).
3. State by state analysis and support for the expansion of Medicaid programs. The weakest link will set the lowest bar for others to follow. The “fight” has shifted from Washington, D.C., to state capitals.
4. Once the programs outlined in No. 3 are set, the focus will shift with how ACOs will be developed at regional and local levels. 
5. Continue to support the state by state RxP movement. 
6. Train psychologists to become more engaged advocates through implementation of advocacy programs such as 360 Degree Advocacy (Karen Postal and IOPC).
7. Help APA members understand the structure of APAPO and their expansive and critical activities for the practice of psychology. 

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