Psychologists who practice as salaried employees may, on occasion, find that their professional responsibilities to their clients are in conflict with the demands of their organization. This problem is illustrated in the firing of a Veterans Administration (VA) psychologist who objected, first internally and then publicly, to VA policies that he believed jeopardized the health and well-being of his patients. The responses of the VA, the Civil Service Commission, professional associations, and others to this incident, which are examined here in detail, reveal a series of threats to the integrity of professional practice in institutional settings. Vigorous effort, therefore, is needed to safeguard psychology's status as a profession and the ability of its practitioners to act in the public interest. Several suggestions are offered for achieving this goal.The conflict between individual conscience and organizational policy is not a new problem. What is perhaps new is the increased attention this problem has received during the last decade spurred on by the antiwar movement, on one hand, and the consumerist movement led by Ralph Nader, on the other. Nader (1972), for instance, has helped to popularize the term whistle blower to describe the individual in government or industry who calls attention to waste, inefficiency, illegality, or other forms of wrongdoing practiced by his or her organization.Although whistle blowing is an issue of wide social relevance, it has particular significance for psychologists, and other professionals, who are salaried employees. Because they occupy two statuses simultaneously, professional and bureaucrat, the opportunities for conflict between the demands of their conscience and those of their organization are greatly increased in comparison to other employees. The separation between employer and client may force a choice between loyalty to the organization and loyalty to professional ethics, a situation not faced by the traditional self-employed professional. The resolution of such conflicts may require the psychologist either to acquiesce in professionally unconscionable practices or to expose the practices publicly. Thus, whistle blowing, for psychologists, may not only be a matter of personal conscience but a professional responsibility as well (Suchotliff, Steinfeld, & Tolchin, 1970).It is also a matter of high personal risk. Intense economic and organizational pressures appear to have successfully stifled much internal dissent and to have maintained whistle blowing as a rare and personally costly response (Committee on Scientific Freedom and Responsibility, 1975; Nader, Petkas, & Blackwell, 1972;Peters & Branch, 1972). As a result, both the public and the profession stand to suffer. Clients and the community at large may be subjected to unnecessary danger or expense while psychology's ability to function as an independent, autonomous profession is attenuated. Psychologists, therefore, have an important stake in what happens to their colleagues who become whistle blowers. Accordin...
Public interest activities of 990 American Psychological Association (APA) members were surveyed using a 38-item public interest questionnaire. Activities are presented in terms of the percentage of psychologists performing them, the amount of time invested during a 12-month period, and the extent to which they were uncompensated. Results show every activity to have drawn at least some reports of participation, with frequencies ranging from 2% to 67% of the sample. Slightly more than one half of the activities are primarily uncompensated. As we define the term, 4% of the respondents say they did no public interest work during the past year. At the other extreme, 9% report doing public interest work on almost a full-time basis (between 1,000 and 2,000 hours a year). The median APA member reports spending nearly 300 hours a year on public interest activity. This survey is the first to provide a baseline measure of public interest activity and will help psychology to monitor and encourage such activity in the future. It does not answer the question of whether APA members spend "enough" time in public interest work. That is a value commitment we urge psychologists, individually and collectively, to reconsider in light of our findings.One of the significant developments in American society in the last decade has been the emergence of the public interest movement. Long identified with law, public interest groupings have appeared in a variety of other scientific and professional disciplines, including psychology. It is widely assumed by public interest advocates that members of these disciplines do not participate adequately in public interest activities. Thus, addressing the 1976 American Psychological Association (APA) meeting in Washington, D.C., Ralph Nader called on psychologists to develop a greater "public interest dimension" to their work ("Nader Chides Researchers," 1976).Nader's concern is reflected in several developments within the discipline. In 1974 an ad hoc Committee on Promoting Public Interest Activity (COPPIA) was established by the APA's Board of
Cost containment and quality control are the major purposes of professional practice review (PR). PR appears to more effectively control utilization of services than cost per unit. PR may increase quality of service by establishing a better data base for evaluating treatment and outcome. Quality and cost, however, are interrelated. Optimal quality may raise cost of care. Although PR may decrease costs and increase quality, it may also infringe on the privacy of the clients and narrow their freedom in choosing a provider. Consumers need to be involved to make sure that PR addresses issues of importance to them, such as humaneness of treatment and control of poorly prepared providers.This article discusses some ways in which professional practice review (PR) may affect the consumer of mental health services. PR is used as a generic term for any method that systematically scrutinizes health care, including peer review, quality assurance, medical audit, professional services accounting, Professional Standards Review Organizations (PSROs), Professional Standards Review Committees (PSRCs), utilization review, and claims review. These approaches differ in whether they emphasize cost containment or quality of care; in whether the review is conducted prospectively, concurrently, or retrospectively; and to what extent nonhealth providers participate in the process. However, all of these approaches may be labeled PR.PR standards may be established descriptively or prescriptively. Descriptive standards, alsd called "empirical" or "statistical," are typically used in insurance claims review when determining whether a given practice is "usual, customary, and reasonable" (UCR). Since a descriptive standard "depends upon average clinical practice," an activity may meet the standard "and yet still be below what most persons would agree is minimally adequate" (Zusman & Ross, 1969, p< 353). Professors who grade on a curve are familiar with this phenomenon. In addition, the standards are usually determined on a local rather than on a national basis. As a result consumers living in one area may receive care that is considered inadequate or overpriced in another. Prescriptive standards, also called "clinical," "a priori," or "normative," avoid the relativism of descriptive standards because they are based on the judgment of a select group of experts. This doesjiot necessarily mean, however, that prescriptive standards will lead to more effective or less costly care. In the absence of validating research, such standards may merely reflect the practice prejudices of the experts. Even if valid, prescriptive standards may lead to therapeutic overkill and needless expense (Institute of Medicine, 1974). Effects on CostMuch of PR's impetus in the last decade has come from the desire to control the cost of health services. A crucial question then is, Will PR save consumers money? The experience of one California clinic may provide an answer (Kazanjian, 1982;
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