2018 APA presidential candidates answer questions about practice

The APA Practice Organization, a companion organization to the APA, advocates exclusively for professional practice. Given the current financial challenges to the Practice Organization, what will you do to ensure its success?

The Practice Organization needs financial stability. Possible sources for an income stream would be new products and product endorsements, particularly in the technical arena. The development of technology products akin to the APA publication databases could generate substantial funds. This would require investments, and while APA cannot give money to the Practice Organization, it could provide a loan to start such a project.

Another possible source could involve The Trust. In exchange for endorsements, APA netted $10 million. Of that sum, the Practice Organization only received a fraction and was not involved in the decision making. When this agreement comes up for renewal, the Practice Organization can advocate to have the primary right to any fees, since The Trust’s customers are practitioners.

What do you believe are the most important opportunities and challenges in professional practice, and how would you address them? 

My campaign focuses on promoting the concept of citizen psychologists. We have well qualified independent practitioners in all the states, provinces and territories. They have significant potential to alter how psychology is viewed and accepted in public life. I have repeatedly noted that, “Psychology is every day in every way.” Engaging participation by psychologists in their respective communities can educate the electorate about the importance of incorporating psychological science and practice into decisions about policies and programs at the local and national levels. By joining key boards and committees, psychologists can have a powerful impact.

I want our training programs (internships and postdoc fellowships) to incorporate the importance of being citizen psychologists by using their knowledge as practitioners and researchers.

Independent practices are an integral part of the fabric of psychology. Practitioners matter and we must help our colleagues become more effective advocates for psychology.

The APA Practice Organization, a companion organization to the APA, advocates exclusively for professional practice. Given the current financial challenges to the Practice Organization, what will you do to ensure its success?

The Practice Organization is the single best vehicle for federal advocacy and provides considerable support for state-level advocacy — advocacy that benefits all psychologists. As president, I will communicate the centrality of such advocacy without which psychologists and psychology suffer. While the Practice Organization enjoys close relationships with many state associations, we need even closer links with state associations and particularly their members. The support the Practice Organization provides to states is not widely known among individual psychologists, and that deficit must be remediated.

We must have better and stable funding for the Practice Organization. It has been continually underfunded even though most health-related psychological practitioners rely on its work. I would immediately charge the Finance Committee, Membership Board and the Committee for the Advancement of Professional Practice to recommend budgeting and membership models. Specifically, I will consider models in which members have a right to allocate a portion of their membership fees in ways that best support their interests. We cannot dismantle APA as a 501(c)3, but we can provide members more choice in their allocations. One option would be to ask the three above named committees to identify individuals to form a task force charged to propose possible approaches for revitalizing the Practice Organization fiscally. As a scientist and administrator who practices, I can lead these changes. In my responses to the APA Monitor questions, I also suggested that APA and Practice Organization membership should be made more attractive to individuals in several groups, one of which is state association members. Extending services for interns may also help graduates to belong to the practice organization.

What do you believe are the most important opportunities and challenges in professional practice, and how would you address them?

In many ways, the opportunities and challenges parallel each other. One challenge is our lack of parity with physicians in Medicare and other programs; the opportunity is to obtain that parity across the board. A second is the ACA preference for work in institutional settings. Several other interrelated challenges include regressive reimbursement rates, unfair control of rates by insurance companies, psychotherapy codes and their diminished valuations, devaluation of psychotherapy and attendant over-reliance on psychoactive medication, high costs of national and state association dues and limited resources for practice advocacy. I would, of course, appreciate hearing other thoughts from Practice Organization members and its leaders.

Many of these proposed actions are continuations of current APA or Practice Organization practices that are unable to be effectively implemented given funding constraints. At the same time, the Practice Organization needs to help professional psychologists understand and negotiate the new world of 21st century health care, finding new and alternative ways to best practice.

Practice Organization staff have been attending meetings on reimbursement codes held by the American Medical Association. We must continue to be at that table. Our advocacy at that table should lead to: 

• Positioning psychologists as primary-care practitioners for mental health, health and addictions.
• Maintaining meaningful reimbursement levels for patients served under Medicare, Medicaid and the Affordable Care Act.
• Securing reimbursement for psychological services provided by interns.
• Advocating for psychologists as experts on behavior change, treatment compliance and body-mind interface.
• Encouraging the use of psychologists as part of interdisciplinary health teams.

The APA Practice Organization, a companion organization to the APA, advocates exclusively for professional practice. Given the current financial challenges to the Practice Organization, what will you do to ensure its success?

Not for want of effort, the current Practice Organization business model is not working. Although there is a demonstrated need for continued lobbying on regulatory issues that adversely affect psychologists in health/mental health practice, it is unclear how much those in practice are willing to pay for such efforts, particularly those with large debt loads and income challenges. Yet, when people perceive that they are being provided value that directly benefits them, they are usually willing to pay to support those efforts.

A new strategic plan for the Practice Organization must rethink what it means to be in the professional practice of psychology in today’s context and moving forward. Such a plan must put forth bold new models that advance the scope of professional practice within the parameters of professional competence. (A start in that direction can be found in the Spring/Summer 2016 issue of Good Practice, the Practice Organization’s magazine, on “Expanding the Practice Spectrum.”) A revised strategic plan must also consider sources of financial support beyond the special assessment that will help advance the Practice Organization’s important mission.

Additionally, the Practice Organization currently limits its members to those who are licensed to practice psychology. Yet there are other psychologists who may not need a license to practice but need help in fighting their particular regulatory battles. Additionally, the ability to practice competently and effectively using electronic means opens up huge new markets — and also a number of regulatory issues. Envisioning the future must be part of any new Practice Organization strategic plan.

What do you believe are the most important opportunities and challenges in professional practice, and how would you address them? 

The independent practice of psychology needs to be broadened in both scope and opportunities. Understandably, we are somewhat stuck in models that are heavily controlled by regulation. That is one way to practice psychology but too often it defines and restricts psychologists and the results are usually at best incremental, not game-changing. Beyond expanding legal scope of practice, there are other ways to expand the practice of psychology.

First, the science and research base of what we practice must always be expanding and continually rising in its complexity. When the knowledge base of our practice, supported by credible research on efficacy, is rapidly increasing, we are more likely to retain “ownership” of the areas in which we practice. Otherwise, third-party payers and others seek out the lowest bidders for what is seen as a generic commodity.

Second, prescriptive authority for appropriately trained psychologists will increase the services psychologists can provide. The recent successes in Illinois suggest that other states, including large ones, can also succeed in this change. Consideration should also be given to allowing this training to be part of graduate school, not just of postgraduate, curricula.

Third, we are in the midst of a major revolution in the electronic delivery of psychological services, including assessment and intervention. APA and the Practice Organization have the opportunity to lead the charge in the virtual delivery of services since those potentially open up the entire world as a venue in which our services can be offered.

The APA Practice Organization, a companion organization to the APA, advocates exclusively for professional practice. Given the current financial challenges to the Practice Organization, what will you do to ensure its success?

The Practice Organization is too important to fail. It ensures we have the opportunity to continue practicing psychology by championing our causes on Capitol Hill, in the courts and healthcare marketplace. The Practice Organization provides critical professional tools, helps state psychological associations defend our scope of practice and supports political candidates who understand the value of psychology.

But we are facing a membership crisis. The Practice Organization has lost 40 percent of its members over the last decade. Its revenue has declined from $5.6 million in 2007 to $3.2 million today. Consequently, the Practice Organization is being forced to scale back its efforts.

What happened? I believe psychologists are reluctant to join the Practice Organization because the organization did not communicate honestly in the past, leading to a class action lawsuit. To survive, we must rebuild trust, provide tangible value and cultivate a culture of advocacy.

This begins by focusing on the 21st century’s most powerful advocacy tool — online video. An ongoing Practice Organization YouTube series could tell the story of the organization — why it exists, how it works and the issues we care about. Next, I suggest the organization develop resources aimed at early and mid-career psychologists. These could potentially include toolkits that help psychologists launch and grow modern practices. Finally, the Practice Organization could partner with divisions and state, provincial, and territorial psychological associations to create a “National Psychologists Week” with the goal of increasing awareness of our work, train a new generation to advocate for our profession and foster connections with community leaders.

What do you believe are the most important opportunities and challenges in professional practice, and how would you address them? 

This is an exciting time for professional psychology. Our field has become a critical component of healthcare. Medical schools now require all incoming students to have a foundational knowledge of psychology. Medical research continues to reinforce the need for psychological interventions when treating obesity, preventing HIV and promoting immunization. Consequently, medical practice is moving towards the integration of mental health with physical health.

Our greatest challenge to capitalize on these opportunities remains our reluctance to change. We have spent decades practicing psychology in silos — private practices, clinics or departments. We often work independently, focus exclusively on mental health and maintain a 50-minute structure for our interventions.

Being overly focused on tradition has made us slow to prepare our workforce for emerging healthcare marketplaces. While current models will remain sustainable for the near future, early and mid-career psychologists need to expand their practices to thrive in future marketplaces. If we do not prepare for these changes, our profession will be fighting over the crumbs of healthcare while other disciplines will be eating cake.

As president-elect of APA and the Practice Organization, I will focus on the following:

• Advocate for the inclusion of psychologists in all aspects of healthcare reform implementation.
• Encourage graduate training that helps students apply psychological interventions towards population-based problems such as diabetes, heart disease, cancer and dementia.
• Help psychologists to diversify their practices beyond mental health.
• Provide resources that will help psychologists take advantage of new reimbursement systems (e.g., bundled payments) by easily demonstrating the value of their existing treatments.

The APA Practice Organization, a companion organization to the APA, advocates exclusively for professional practice. Given the current financial challenges to the Practice Organization, what will you do to ensure its success?

The Practice Organization relies largely on dues for its budget, yet membership has fallen 40 percent since 2008. Clearly the Practice Organization’s authority and effectiveness have been limited by the membership crisis. If we are to reverse this trend, we must understand its causes. There are at least three: First, our members, particularly early career psychologists (ECPs), have faced economic pressures over the past decade. Second, many members experienced a breach of trust — with APA, due to the interrogations scandal, and the Practice Organization, due to the dues controversy and subsequent lawsuit. Finally, many practitioners associate the Practice Organization primarily with the fight for prescription privileges, a costly effort that many believe has been of benefit to only a few practitioners.

Our task is to turn each of these crises into an opportunity. We must demonstrate to our members that the Practice Organization remains our greatest resource for advocating for psychologists’ economic future; that the Practice Organization has learned the lessons of the lawsuit and now will ensure that transparency, integrity and respect guide our relationship with our members; and that we have listened to the needs of all practitioners and have developed broad-based national and local advocacy strategies based on expressed member and state organization needs and values. As a practitioner for 25 years, I have long argued that psychology, as a profession, should be a guiding light for human welfare, social justice and the public good. With the Practice Organization, I will fight just as strongly in advocating for practicing psychologists, so that we can continue to be that guiding light. 

Steven J. Reisner's websiteopens in new window.

What do you believe are the most important opportunities and challenges in professional practice, and how would you address them?

The practice of American psychology is changing in challenging ways. In this new climate, the Practice Organization must advocate for expanded roles for psychologists and prepare us to take them on by providing training and education opportunities. Simultaneously, we must preserve what is best in the present system of practice. Our advocacy must stem from the aspirations and values that young and old alike bring to the field: the desire to use our best talents, education and research for the good of others, and to be able to make a living doing it. 

Practitioners at differing levels of experience have different needs and the Practice Organization must advocate for each — from early-career to established practitioners, in private practice and in public roles. ECPs need us to advocate for fair student loan practices and the expansion of the Public Service Loan Forgiveness Program for ECPs working for the public good. Midcareer psychologists need support to adapt to and thrive in a changing world of integrated care, so psychologists’ skills can be expanded into new roles. Practitioners in established private practices need the Practice Organization to advocate for out-of-network benefits under the Affordable Care Act, and ensure that parity is operational and effective in all states.  We should ensure that “evidence-based practice” doesn’t mean cherry-picking evidence, but supporting all validated methodologies. The extraordinary diversity of approaches and forms of treatment offered by American psychologists is one of the great strengths of our profession; we should seek to preserve it, even as we transition into new forms of care.