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Clinical Neuropsychology in North America: What the First Twenty Five Years Might Tell Us About the Future of the Specia

Clinical Neuropsychology in North America: What the First Twenty Five Years Might Tell Us About the Future of the Specialty. Antonio E. Puente Department of Psychology University of North Carolina at Wilmington Wilmington, North Carolina 28403 www.uncw.edu/people/puente

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Clinical Neuropsychology in North America: What the First Twenty Five Years Might Tell Us About the Future of the Specia

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  1. Clinical Neuropsychology in North America:What the First Twenty Five Years Might Tell Us About the Future of the Specialty Antonio E. Puente Department of Psychology University of North Carolina at Wilmington Wilmington, North Carolina 28403 www.uncw.edu/people/puente www.clinicalneuropsychology.us puente@uncw.edu

  2. Outline • Introduction • Brief Overview of Twenty Five Years • Current Status • Projections for the Future • Challenges, Pitfalls and Opportunities

  3. History: Organizational • American Psychological Association • Division of Clinical Neuropsychology (40) • National Academy of Neuropsychology • International Neuropsychological Society • Other issues/groups; • APA’s First Specialty (1996) • Board Certification (e.g., ABPN) • Licensure (e.g., Louisiana) • Specialty Groups (e.g., Pediatrics)

  4. History: Informational • Publications • Books • Journals • Online • Trends • Assessment • Rehabilitation • Forensic

  5. History: Personnel • Overall Trends • Growth Patterns • Demographic Patterns • Academic Vs. Clinical • Individuals • Reitan • Golden • Kaplan • Others

  6. History: Clinical Activities • Assessment • Fixed Battery (Halstead-Reitan Vs. Luria-Nebraska) • Flexible Approach • Rehabilitation • Cognitive Rehabilitation • Forensic • Disability • Worker’s Compensation

  7. Current Status: Review of the Surveys • Brief History of Surveys • Hartlage • DeLuca & Putnam • Current Survey Methodology • Sweet & Peck • Division 40 and NAN

  8. 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

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

  10. What is Clinical Neuropsychology? • Study and practrice of the relationship between brain and behavior, especially in neurological patients • Approximately 4-5,000 (out of 150,000) • Doctorate with post-doctorate training is minimum requirement • Difficulties in agreement of definition

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

  12. 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

  13. Organizational Membership(All Doctoral Licensed Clinicians) Percent

  14. 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%

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

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

  17. Work Status(All Doctoral Licensed Clinicians) Percent

  18. Work Setting(All Doctoral Licensed Clinicians) Percent

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

  20. Board Certification Status(Doctoral Licensed Clinicians) Percent

  21. Weekly Professional Activities by Organization Percent

  22. Weekly Professional Activities by Organization Percent

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

  24. Incomes by Organization(Doctoral Licensed Clinicians Working Full Time or Full Time+) $

  25. 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 *=.05 **=.01 Negative correlations in red. “Work Setting” above limited to Private and Institution All ns between 775 and 1185

  26. Income by Years of Licensure Stratification - Mean (Median) ‘Starting’ Salaries - Mean (Median)

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

  28. HOURS/Week Clinical Activity

  29. Evaluation Time by Evaluation Goal (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.

  30. 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

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

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

  33. 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)

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

  35. CPT: Background • American Medical Association • Developed by Surgeons (& Physicians) in 1966 for Billing Purposes • 7,500 Discrete Codes • HCFA/CMS • AMA Under License with CMS • CMS Now Provides Active Input into CPT • Congress • Trent Lott (2001)

  36. Time for the Future • Is History the Best Predictor for Our Future? • What are APA Members Worried About? • My Own Personal Glimpse Into What Awaits Clinical Neuropsychology

  37. Initial Results of APA Policy & Planning 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

  38. What Trends Are Developing • Organizational • Informational • Professional (versus Clinical) • Financial • Public Policy

  39. Immediate Predictions Income (depends on activity; if clinical) • Steadier (if economy does not further erode) • Probable incremental declines, up to 10-20% • “Final” stabilization by 2005 • Recognition • Physician Level • Mental vs. Physical Health • Paradigms • Industrial vs. Boutique • Health vs. Non-Health

  40. Potential Overall Trends • Catching up to Psychiatry • Leaving Psychiatry • Joining Medicine • Leaving Medicine • Legal • Sports • Governmental • Industrial

  41. Future Problems • Empirical Data Base • Limited Understanding of Culture • Continued Professional Infighting • Personnel Issues • Value to Society (face vs criterion validity)

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

  43. Defining the Future… • New Paradigm = Change

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