Status of Psychology & Clinical Neuropsychology in the USA

1. Status of Psychology & Clinical Neuropsychology in the USA • Antonio E. Puente • Department of Psychology • University of North Carolina at Wilmington • Wilmington, NC 29403 • puente@uncwil.edu • Universidad de la Habana • Julio 1, 2002

3. Outline of Presentation • APA at a Glance • Clinical Neuropsychology in Detail • Perspectives of Clinical Practice • Future Concerns & Directions

4. Year Doctorate Masters Bachelors 1970 1505 457 2975 2183 19077 14602 1980 1921 1333 4096 5812 15440 26653 1990 1566 2245 3377 7353 15336 38616 2000 1405 2905 3552 10913 17402 56600 APA Membership

5. APA Membership by Division • Approximately 150,000 members • Approximately 50 different divisions • Top three divisions are: • Clinical Psychology • Clinical Neuropsychology • Independent Practice

6. Related Disciplines • Psychiatry 26,843 • Social Work 92,841 • Psych Nursing 17,318 • Counseling 108,104 • Family Therapist 44,225 • Psysocial Rehab 9,337 • School Psychology 31,278

7. What is Clinical Neuropsychology? • Study and practrice of the relationship between brain and behavior, especially in neurological patients • Approximately 4-5,000 • Doctorate with post-doctorate training is minimum requirement

8. Survey of Clinical Neuropsychology • National Academy of Neuropsychology • Division of Clinical Neuropsychology of the APA • Surveyors: Jerry Sweet & Ted Peck • Date: 2001-2002

9. Actual Return Rate 1569 returns 5791 mailed 1569/5791 = 27.1% Adjusted Return Rate Or returns, 1406 U.S., Doctoral, Licensed, Clinicians Of mailed, 1590 excluded (duplicates, unintended, undelivered) 1406/4201 = 33.5% Survey Return Rates

10. Organizational Membership(All Doctoral Licensed Clinicians) Percent

11. Gender (All Doctoral Licensed Clinicians vs. Younger Samples) Percent Age: Males = 48.6 (n=866) Females = 45.5 (n=524) Years Since Licensed: Males = 14.6 (n=855); Females = 10.1 (n=508) ---------------------------------- Among licensed <10 years: (n=525) Males = 48.6% Females = 51.4% Among licensed <5 years: (n=216) Males = 36.6% Females = 63.4%

12. Type of Doctoral Degree(All Doctoral Licensed Clinicians) Percent

13. Field of Doctoral Degree(All Doctoral Licensed Clinicians) Percent

14. Work Status(All Doctoral Licensed Clinicians) Percent

15. Work Setting(All Doctoral Licensed Clinicians) Percent

16. Gender Within Work Setting(Doctoral Licensed Clinicians) Percent

17. Board Certification Status(Doctoral Licensed Clinicians) Percent

18. Weekly Professional Activities by Organization(All Doctoral Licensed Clinicians, exc. Part time) Percent

19. Weekly Professional Activities by Organization(% for All Doctoral Licensed Clinicians, exc. Part time) Percent

20. Percentages of Reimbursement Sources(For All Doctoral Licensed Clinicians)

21. Years licensed .27** Work Setting -.25** % Forensic .24** Gender -.21** % Self Pay .19** Age .18** Hrs billed/Eval .13** % Public Aid -.12** % Medicare -.09* % Man. Care -.09* % Indemnity .07 % Indigent -.04 Correlates of Income(Rational selection; Full time and Full time +) *=.05 **=.01 Negative correlations in red. “Work Setting” above limited to Private and Institution All ns between 775 and 1185

22. Income by Work Setting(Doctoral Licensed Clinicians Working Full Time or Full Time+)

23. Hours Per Week Per Clinical Activity(Full-time and Full-time plus Doctoral Licensed Clinicians)

24. Evaluation Time by Evaluation Goal(Hrs. for All Doctoral Licensed Clinicians; 5th & 95th%ile in parens.) (Except forensic, those using assistants test more hours (e.g., for determination of diagnosis, 6.6 hrs vs. 5.8 hrs, p=.017.) However, hours billed are similar.

25. Time-Related Case Activities(All Doctoral Licensed Clinicians) Minutes Hours billed: Private=11.1 (SD=5.0); Institution=8.2 (SD=3.3) * Only scoring is not significant between groups; covarying amount of forensic practice did not eradicate group differences

26. Use of Testing Assistants(All Doctoral Licensed Clinicians) Percent

27. Use Of Testing Assistants By Work Setting Percent Using Assistants (n=1349)

28. CPT Code for Activities Frequency Percent Intake Interview 90801 96117 96115 Other (16 codes) 231 106 40 21 16.5 7.6 2.9 1.5 Clinical interview/history 90801 96117 96115 Other (20 codes) 250 180 59 34 17.9 12.9 4.2 2.4 Test administration 96117 96100 96115 Other (12 codes) 498 37 9 21 35.7 2.7 0.6 1.5 CPT Codes Used For Neuropsych Assessment Activities (Doctoral Level Clinicians)

29. CPT: Applicable Codes • Total Possible Codes = 7,500 • Possible Codes for Psychology = Approximately 40 to 60 • Sections = Five Separate Sections • Psychiatry • Biofeedback • Central Nervous Assessment • Physical Medicine & Rehabilitation • Health & Behavior Assessment & Management

30. Current Problems • Definition of Physician • Supervision • Face-to-Face • Time • RVUs • Qualification of Technicians • Payment • Focus for Fraud & Abuse

31. Predictions for Future • Science???? • Income • Steadier (if economy does not further erode) • “Final” stabilization by 2005 • Recognition • Physician Level • Mental vs. Physical Health • Paradigms • Industrial vs. Boutique • Health vs. Non-Health

32. Future Problems • What Will be Future of Training Programs? • Again, where are you “science”??? • Health Care vs. ? • Who will take care of “mental health” patients? • Will “mental health” & psychotherapy be MS level? • What about prescription privileges?

33. Initial Results of APA Survey • Procedure • Five Year Review of Status of APA & Psychology • Random Survey of APA Membership, Staff, & Governance • Results • Public Image of Psychology • Protecting & Expanding Sources of Income • Membership Concerns

34. What About Our Students • Sex Differences • Competition from Classically Well-Defined Professions (e.g., medicine) • Limited Scientific Base • Attitudinal-Personality Traits

35. Summary • Continued Growth • Especially in the Clinical Domains • Expansion Beyond Mental Health, to Health, to Other Areas • Vibrant and Unpredictable yet Exciting

36. Defining the Future… • New Paradigm = Change • Be Prepared • Contribute • Enjoy